Endoscopic suturing system

ABSTRACT

An endoscopic treatment device is used with an endoscope. This treatment device includes a transmission member with a flexible structure having a distal end portion to be inserted into a body and can be operated outside the body, a push rod coupled to the distal end portion, and first and second connecting members rotatably coupled to the push rod. The treatment device further includes first and second arm members rotatably coupled to the distal end portion of the connecting member, a holding member rotatably holding the respective arm at a predetermined interval therebetween, and first and second actuating members integrally formed with the arm members and can open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod. This device also includes a needle mounted on at least one of the first and second actuating members.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.60/352,728, filed Jan. 30, 2002; and No. 60/430,259, filed Dec. 2, 2002.

BACKGROUND OF THE INVENTION

The present invention relates to a treatment device which can beinserted into a body together with an endoscope. U.S. Pat. No. 5,171,258(Symbiosis Co., Ltd.) discloses a medical instrument that is applicableto a surgical operation using a laparoscope. This medical instrumentcomprises a pair of posts for supporting a pair of devises in order toproduce a large force required to grip a thick tissue. However, theposts and devises interfere with each other, whereby an angle that canbe formed between the devises is restricted to an angle of about 90degrees.

On the other hand, where the inside of a body is sutured by using anendoscope, it is required to puncture a needle through a tissue.Therefore, a treatment device is required to be a small size,nevertheless the treatment device being capable of moving a needle overa large angle, is required. Further, it is required to transmit a largeforce to the needle in order to securely puncture the tissue.

However, in the prior art, a treatment device for endoscope requiring alarge opening/closing angle and transmission of a large force cannot beprovided.

BRIEF SUMMARY OF THE INVENTION

The present invention has been made in view of the above describedcircumstance. It is an object of the present invention to provide anendoscopic treatment device comprising a structure for furtherincreasing an opening/closing angle and further producing a large force.

According to an aspect of the present invention, there is provided atreatment device which is used to perform treatment in a body by beingoperated outside the body. This treatment device comprises a flexiblemember having a distal end portion that can be inserted into a body, alink mechanism which is arranged at the distal end portion of theflexible member and actuated by an operation outside the body, and acurved needle which is actuated by the link mechanism and can move in adirection to puncture a tissue and a direction to be removed from thetissue.

According to another aspect of the present invention, there is providedan endoscopic treatment device which is used together with an endoscopeto perform treatment in a body by being operated outside the body. Thisendoscopic treatment device comprises a transmission member with aflexible structure which has a distal end portion inserted into a bodyand can be operated outside the body, a push rod coupled to the distalend portion of the transmission member, first and second connectingmembers coupled to the push rod, each of the first and second connectingmembers having a distal end portion and a proximal end portion rotatablycoupled to the push rod, first and second arm members each having adistal end portion and a proximal end portion rotatably coupled to thedistal end portion of a corresponding one of the first and secondconnecting members, a holding member which rotatably holds the distalend portions of the respective arm members at a predetermined intervaltherebetween, first and second actuating members which are integrallyformed with the distal end portions of the arm members and canopen/close when the transmission member actuates the first and secondconnecting members and the first and second arm members through the pushrod, and a needle which is mounted on at least one of the first andsecond actuating members and is used to puncture a tissue.

According to still another aspect of the present invention, there isprovided an endoscopic treatment device which includes recovery meansfor recovering the thread inserted into a tissue from a needle, whereinthe recovery means has a lock member which detaches the needle from oneof the first and second actuating members.

According to sill another aspect of the present invention, there isprovided an endoscopic treatment device comprising recovery means whichis used together with an endoscope to recover a thread inserted into atissue to perform treatment in a body by being operated outside thebody, wherein the recovery means has a needle lock member which can locka needle, and a thread lock member which can lock a thread, therebyforming needle/thread fixing means which can clamp a tissue between theneedle locked to the needle lock member and the thread lock member.

According to still another aspect of the present invention, there isprovided an endoscopic treatment device comprising a restrictionmechanism which is mounted on at least one of first and second actuatingmembers which can open/close, and restricts a movement range of oneactuating member.

According to still another aspect of the present invention, there isprovided an endoscopic treatment device which is used together with anendoscope to perform treatment in a body by being operated outside thebody. This endoscopic treatment device comprises a transmission memberwith a flexible structure which has a distal end portion inserted into abody and can be operated outside the body, a push rod coupled to thedistal end portion of the transmission member, first and secondconnecting members coupled to the push rod, each of the first and secondconnecting members having a distal end portion and a proximal endportion rotatably coupled to the push rod, first and second arm memberseach having a distal end portion and a proximal end portion rotatablycoupled to the distal end portion of a corresponding one of the firstand second connecting members, a holding member which rotatably holdsthe distal end portions of the respective arm members at a predeterminedinterval therebetween, first and second actuating members which areintegrally formed with the distal end portions of the arm members andcan open/close when the transmission member actuates the first andsecond connecting members and the first and second arm members throughthe push rod, a third actuating member which is pivotally attached tothe first actuating member, a third connecting member which is pivotallycoupled to the holding member and the third actuating member and movestogether with the first and second actuating members, and a needle whichis mounted on at least one of the first and second actuating members andis used to puncture a tissue.

Additional objects and advantages of the invention will be set forth inthe description which follows, and in part will be obvious from thedescription, or may be learned by practice of the invention. The objectsand advantages of the invention may be realized and obtained by means ofthe instrumentalities and combinations particularly pointed outhereinafter.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the invention, andtogether with the general description given above and the detaileddescription of the embodiments given below, serve to explain theprinciples of the invention.

FIG. 1 is an illustrative view showing an entire configuration of anendoscopic suturing system according to a first embodiment of thepresent invention;

FIG. 2 is an enlarged view of an endoscope and a suturing device shownin FIG. 1;

FIG. 3 is an illustrative view showing a state in which first and secondactuating members of the suturing device are closed;

FIG. 4 is an illustrative view showing a state in which the first andsecond actuating members of the suturing device are opened;

FIG. 5 is a sectional view showing an internal structure of the suturingdevice of FIG. 3;

FIG. 6 is a sectional view showing an internal structure of the suturingdevice of FIG. 4;

FIG. 7 is a sectional view taken along the line A-A of FIG. 5;

FIG. 8 is a view seen in a direction indicated by the arrow B of FIG. 4;

FIG. 8A is a view showing a suturing device when an endoscope isremoved, the view being similar to FIG. 8;

FIG. 9 is a sectional view taken along the line C-C of FIG. 7;

FIG. 10 is a sectional view taken along the line D-D of FIG. 7;

FIG. 11 is a sectional view taken along the line E-E of FIG. 7;

FIG. 12 is a sectional view taken along the line F-F of FIG. 13;

FIG. 13 is a view seen in a direction indicated by the arrow G of FIG.7;

FIG. 14 is a view showing a hook of a thread-catching-device when asuture thread is hooked;

FIG. 15 is a view showing a hook of a thread-catching-device when thesuture thread and hook are retracted into a sheath;

FIG. 15A is a view showing an outer appearance of anotherthread-catching-device;

FIG. 15B and FIG. 15C are views showing how the thread-catching-devicecatches a thread by using a hook;

FIG. 16 is a schematic longitudinal cross section of an insert assistingdevice;

FIG. 17 is an illustrative view showing a state in which an endoscopehaving a suturing device mounted thereon is housed in an insertassisting device;

FIG. 18 is an illustrative view showing a state in which the endoscopehaving the suturing device mounted thereon is protruded from the insertassisting device;

FIG. 19 is a view showing a modified example of a valve mounted on theinsert assisting device;

FIG. 20 is a view showing the insert assisting device according to amodified example when the endoscope and the suturing device are mounted;

FIG. 21 is a view showing a state in which the endoscope and thesuturing device are protruded from the insert assisting device of FIG.20;

FIG. 22 to FIG. 27 each show a suturing procedure using the suturingdevice, wherein FIG. 22 is a view showing a state in which a curvedneedle is proximal to a tissue;

FIG. 23 is a view showing a state in which the curved needle punctures atissue;

FIG. 24 is a view showing a state in which the thread-catching-devicehooks the suture thread;

FIG. 25 is a view showing a state in which the suture thread isretracted into a flexible tubular member together with the hook when thethread is hooked;

FIG. 26 is a view showing a state in which the thread-catching-device ispulled out from an instrument channel port;

FIG. 27 is a view showing a state in which the curved needle is removedfrom the tissue;

FIG. 28 is a view showing a state in which the suturing device isremoved from the cavity together with the insert assisting device;

FIG. 29 is a view showing a state in which a knot is fed into a body byusing a knot pusher;

FIG. 30 is a view showing a state in which the suturing device is housedin a protect member, the figure being similar to FIG. 2 showing anendoscopic suturing system according to a second embodiment of thepresent invention;

FIG. 31 is an illustrative view showing a state in which the suturingdevice is protruded in the endoscopic suturing system of FIG. 30;

FIG. 32 to FIG. 35 are views each showing a protect member in the secondembodiment, wherein FIG. 32 is a view showing a state in which a movableportion is protruded;

FIG. 33 is a view showing a state in which a moving member disengages alock member;

FIG. 34 is a view showing a state in which the movable portion isretracted;

FIG. 35 is a detailed view of the lock member;

FIG. 36 is an illustrative view of the protect member using anendoscopic suturing system according to a third embodiment of thepresent invention;

FIG. 37 to FIG. 41 each show an endoscopic suturing system according toa fourth embodiment, wherein FIG. 37 is a view showing a suturing deviceused therefor;

FIG. 38 is a view showing a state in which a removable needle afterpunctured into a tissue is engaged with a needle thread fixing device;

FIG. 39 is a view showing a state in which an injury is closed by tyingthe suture thread;

FIG. 40 is a view showing a state in which a redundant portion of thesuture thread is cut by a thread cutting device;

FIG. 41 is a sectional view taken along the line H-H of FIG. 37;

FIG. 42 is a sectional view showing a state in which sealing means isincorporated into the frontal side of the insert assisting device shownin FIG. 16;

FIG. 43 is a sectional view taken along the line I-I of FIG. 42;

FIG. 44 is a view showing a suturing device for use in an endoscopicsuturing system according to a fifth embodiment of the presentinvention;

FIG. 45 is a view showing a state in which a removable needle afterpunctured into a tissue is engaged with a needle thread fixing device;

FIG. 46 is a view showing a suturing device for use in an endoscopicsuturing system according to a sixth embodiment of the presentinvention;

FIG. 47 is a view showing a state in which a removable needle afterpunctured into a tissue is engaged with a needle fixing device;

FIG. 48 is a view showing a state in which a knot is formed by a loopremoved from an engagingly lock member when the first and secondactuating members are opened;

FIG. 49 is a view showing a state in which a redundant portion of thesuture thread is cut by a thread cutting device;

FIG. 50 is a view showing a state in which a tissue is sutured while thetissue is pulled by a grasping forceps;

FIG. 51 is a view showing a state for use in an endoscopic suturingsystem according to a seventh embodiment of the present invention;

FIG. 52 is a view showing a state when a removable needle afterpunctured into a tissue is engaged with a needle thread fixing device;

FIG. 53 is a sectional view taken along the line J-J of FIG. 52;

FIG. 54 is a view showing a structure by thread lock means;

FIG. 54A to FIG. 54D are views showing various modifications of the lockmeans;

FIG. 55 is a view showing a state in which a needle holder is removedfrom a tissue;

FIG. 56 is a view showing a state in which a tissue is tied;

FIG. 57 to FIG. 63 each show a suturing procedure using an endoscopicsuturing system according to an eighth embodiment of the presentinvention, wherein FIG. 57 is a view showing a state in which thesuturing device is proximal to a tissue to be sutured;

FIG. 58 is a view showing a state in which a removable needle afterpunctured into a tissue is engaged with a needle fixing device;

FIG. 59 is a view showing a state in which a needle holder is pulled outfrom a tissue;

FIG. 60 is a view showing a state in which the suturing device andendoscope are spaced from a tissue while the needle thread fixing deviceis left;

FIG. 61 is a view showing a state in which a tissue is tied with thesuture thread;

FIG. 62 is a view showing a state in which the suture thread can beseparated;

FIG. 63 is a view showing a state in which a redundant portion of thesuture thread is cut by a thread cutting device;

FIG. 64 is a view showing a suturing device for use in an endoscopicsuturing system according to a ninth embodiment of the presentinvention;

FIG. 65 is a view showing a state in which a removable needle afterpunctured into a tissue is engaged with a needle fixing device;

FIG. 66 is a view showing a tissue when the tissue is sutured;

FIG. 67 to FIG. 99 each show the 10th embodiment, wherein FIG. 67 is asectional view taken along the line A-A of FIG. 68;

FIG. 68 is a view showing an outer appearance of a suturing device (aview taken in the direction of an arrow B in FIG. 67);

FIG. 69 is a view taken in the direction of an arrow C in FIG. 67 (witha partially sectional view);

FIG. 70 is a view taken in the direction of an arrow D in FIG. 69;

FIG. 71 is a sectional view taken along the line E-E of FIG. 69;

FIG. 72 is a sectional view taken along the line F-F of FIG. 69;

FIG. 73 is a sectional view taken along the line G-G of FIG. 69;

FIG. 74 is a view showing the details of the operating section of thesuturing device;

FIG. 75 is a sectional view taken along the line H-H of FIG. 74;

FIG. 76 is a view showing an outer appearance of a pre-knot cartridge;

FIG. 77 to FIG. 80 are views for explaining how a removable needle isremoved by using a needle-catching-device;

FIG. 81 to FIG. 85 are views showing how the removable needle is removedby using the needle-catching-device;

FIG. 86 and FIG. 87 are views showing a state wherein a cover is somounted as to prevent a pre-knot of the pre-knot cartridge from comingoff the needle-catching-device;

FIG. 88 is a view showing an outer appearance of a spring for lockingthe removable needle mounted in the needle-catching-device;

FIG. 89 is a view showing in detail how a pre-knot is formed;

FIG. 90 to FIG. 98 are views showing a suturing procedure;

FIG. 99 is a view showing a needle-catching-sheath as anothermodification of the needle-catching-sheath;

FIG. 100 to FIG. 111 each show the 11th embodiment, wherein FIG. 100 isview showing an outer appearance of a suturing device (a view taken inthe direction of an arrow G in FIG. 102);

FIG. 101 is a partially sectional view of FIG. 100;

FIG. 102 is a sectional view taken along the line A-A of FIG. 100;

FIG. 103 is a view taken in the direction of an arrow B in FIG. 101;

FIG. 104 is a sectional view taken along the line C-C of FIG. 101;

FIG. 105 is a sectional view taken along the line D-D of FIG. 101;

FIG. 106 is a sectional view taken along the line E-E of FIG. 102;

FIG. 107 is a sectional view taken along the line F-F of FIG. 102;

FIG. 108 to FIG. 111 are views showing how the suturing device puncturesthe tissue;

FIG. 112 to FIG. 122 each show the 12th embodiment, wherein FIG. 112 isa view showing an outer appearance of a suturing device (a view taken inthe direction of an arrow G in FIG. 114);

FIG. 113 is a partially sectional view of FIG. 112;

FIG. 114 is a sectional view taken along the line A-A of FIG. 112;

FIG. 115 is a view taken in the direction of an arrow B in FIG. 113;

FIG. 116 is a sectional view taken along the line C-C of FIG. 113;

FIG. 117 is a sectional view taken along the line E-E of FIG. 114;

FIG. 118 is a sectional view taken along the line F-F of FIG. 114;

FIG. 119 to FIG. 122 are views showing how the suturing device puncturesthe tissue;

FIG. 123 to FIG. 126B each show the 13th embodiment, wherein FIG. 123 toFIG. 126A are views showing how the suturing device punctures thetissue;

FIG. 126B is a sectional view of the suturing device;

FIG. 127 to FIG. 128B each show the 14th embodiment, wherein FIG. 127 isa view showing a method of fixing a scope and a suturing device;

FIG. 128A is a sectional view of a tube holder;

FIG. 128B is a view showing an arrangement obtained by mounting aprotecting member in the arrangement shown in FIG. 127;

FIG. 129 to FIG. 143 each show the 15th embodiment, wherein FIG. 129 toFIG. 141 are views showing a procedure for continuously suturing thetissue;

FIG. 142 and FIG. 143 are views showing how a continuous suturingoperation is performed;

FIG. 144 to FIG. 163 each show the 16th embodiment, wherein FIG. 144 isa partially sectional view of a suturing device;

FIG. 145 is a sectional view taken along the line A-A of FIG. 144;

FIG. 146 is a partial sectional view of an end loop cartridge in FIG.158;

FIG. 147 to FIG. 157 are views showing the operation of a suturingdevice when puncturing the tissue;

FIG. 158 is a view showing an outer appearance of the end loopcartridge;

FIG. 159 is a view showing an outer appearance of a lock tubular member;

FIG. 160 and FIG. 161 are views showing a seal structure and operatingsection formed on the proximal end side of the suturing device;

FIG. 162 is a sectional view of the distal end portion of a threadcutting forceps used to cut a suture thread;

FIG. 163 is a view showing another example of the structure of an outersheath;

FIG. 164 is a view showing a state wherein the end loop cartridge isloaded in a suturing device;

FIG. 165 and FIG. 166 are views showing another form of a removableneedle;

FIG. 167 is a view showing a state wherein the suturing device ismounted on an endoscope and the distal end of the suturing device isbrought nearest to the distal end of the endoscope;

FIG. 168 is a view showing a state wherein the distal end of thesuturing device is separated from the distal end of the endoscope;

FIG. 169 to FIG. 171 each show the 17th embodiment, wherein FIG. 169 isa partial sectional view showing a state wherein the first and secondactuating members of a suturing device are open;

FIG. 170 is a partially sectional view showing a state wherein the firstand second actuating members of the suturing device are closed;

FIG. 171 is a sectional view taken along the line A-A of FIG. 169;

FIG. 172 is a view showing a state wherein the tissue is punctured witha suturing device according to the 18th embodiment;

FIG. 173 and FIG. 174 are views showing a modification of a needleholder which can applied to the 10th embodiment;

FIG. 175 and FIG. 176 are views showing another modification of theneedle holder;

FIG. 177 is a view showing a fixing needle which can applied to the 10thembodiment and other embodiments;

FIG. 178 and FIG. 179 each show the 19th embodiment, wherein FIG. 178 isa view showing a state wherein an end loop cartridge is to be mounted inan engage tube, and FIG. 179 is a view showing a state wherein the endloop cartridge is mounted in the engage tube; and

FIG. 180 and FIG. 181 each show the 20th embodiment, wherein FIG. 180 isa view showing a state wherein an end loop cartridge is to be mounted inan engage tube, and FIG. 181 is a view showing a state wherein theengage tube and a hood device are housed in a distal pipe.

DETAILED DESCRIPTION OF THE INVENTION First Embodiment

FIG. 1 to FIG. 29 show an endoscopic suturing system according to afirst embodiment of the present invention. In the respective systemsdescribed hereinafter, although the endoscopic suturing system is used,a gripping forceps, a scissors forceps, a hot biopsy forceps, or arotational clipping device may be used instead of the suturing system.

As shown in FIG. 1, an endoscopic suturing system 1 according to thepresent embodiment comprises an endoscope system 2, a suturing device 3,and a suture thread 4. This suture thread 4 is preferably formed like amonofilament line or stranded wire by using a material such as nylon,polyester, silk, fluoroplastic or bioabsorbable resin. The endoscopesystem 2 comprises an endoscope 12, an image processing device 14, alight source device 15, an observation monitor 13, and a suction device11 as in a generally used videoscope system. The endoscope 12 isconnected to the light source device 15 via a universal code. Then, animage signal delivered from a CCD camera 10 (refer to FIG. 8) at itsdistal end portion is processed in the image processing device device14, and the processed image is displayed on the monitor 13. As bestshown in FIG. 2, although the endoscope 12 is used as having aninstrument channel port 6, an endoscope of such type having twoinstrument channel ports may be used instead thereof.

In addition, as shown in FIG. 8, the CCD camera 10, light guides 8 and9, instrument channel port 6, and lens washing nozzle 11 for the CCDcamera are arranged at a distal end portion of the endoscope 12. Afiberscope with its eyepiece lens may be used instead of the videoscopeusing the CCD. As shown in FIG. 8, although the suturing device 3 isremovably fixed at a distal end of the endoscope 12 by a fixing member40, the suturing device 3 and the endoscope 12 may be structuredintegrally with each other instead thereof.

As shown in FIG. 3 to FIG. 7, the suturing device 3 comprises a flexibletube 73 described later and a holding member 18 fixed at its distal endportion to hold a needle described later. This holding member 18 isformed of: two support plate portions 18 a opposed to each other througha slit 31 (refer to FIG. 7); and a hole 19 (refer to FIG. 5) whichcommunicates with the slit 33 between these support plate portions andan inner hole of the flexible tube 73. In this hole 19, a push rod 20 isdisposed retractably in an axial direction.

At a distal end of this push rod 20, one end of each of first and secondconnecting members 22 and 23 is pivoted via a pin 21. The other end ofeach of the connecting members 22 and 23 is pivoted at a proximal endportion of each of first and second arm members 24 and 25 via pins 26and 27, respectively. Further, a first actuating member 16 formedintegrally with the first arm member 24 is rotatably linked with thesupport plate portion 18 a via a pin 28. Similarly, a second actuatingmember 17 formed integrally with the second arm member 25 is rotatablylinked with the support plate portion 18 a via a pin 29.

In FIG. 7, as is illustrated by the pin 28, the pins 28 and 29 each havean end portion formed by a reduced diameter portion 30. In this manner,the size of the slit 31 defined between the support plate portions 18 aof the holding member 18 is maintained to be slightly larger than a sumof the thickness of the first actuating member 16 and the secondactuating member 17. The first actuating member 16 and the secondactuating member 17 can be moved in the slit 31 without generating aremarkable friction.

As shown in FIG. 7, the push rod 20 is linked with an elongated flexibletransmission member 71. In addition, the holding member 18 is linkedwith coils 72 and 76 that form an axial hole. These coils 72 and 76 arelinked with each other at their end faces opposed to each other bysuitable means such as laser welding, blazing, soldering, adhering orthe like. The coil 76 is formed of an element wire that is more smallerin diameter than the coil 72, whereby the suturing device 3 is formedmore flexibly at its distal end side. These coils 72 and 76 are coveredwith the flexible tube 73 almost all over their full lengths, and isheld so as to be in intimate contact with this flexible tube 73. Thetube 73 restricts contraction in the axial direction of the coils 72 and76, thereby increasing a force for opening and closing the firstactuating member 16 and the second actuating member 17.

As shown in FIG. 2, frontal side end portions of the tube 73 and thecoil 72 are fixed to an operating member main body 77 of an operatingmember 67 of the suturing device. In addition, a frontal side endportion of the transmission member 71 is inserted into the operatingmember main body 77, and is linked with a pipe 74 while it is insertedinto the pipe 74 that is slidable relative to this operating member mainbody 77. This pipe 74 is connected to a movable member 75 by a linkmember (not shown). Therefore, when the movable member 75 is movedrelative to the operating member main body 77, the first actuatingmember 16 and the second actuating member 17 can be opened/closed viathe transmission member 71.

As shown in FIG. 5 and FIG. 6, the first and second arm members 24 and25 can pass through the pins 28 and 29, and can be opened up to an angleshown in FIG. 6. The length of these first and second arm members 24 and25 each and the length of the first and second connecting members 22 and23 each are properly set, whereby an angle between the first and secondarm members 24 and 25 can be further increased or decreased, of course.Needless to say, these members can be opened/closed within the anglerange of 95 degrees or more and less than 360 degrees.

As shown in FIG. 7 and FIG. 11, a stopper pin 32 is fixed to the pushrod 20. The stopper pin 32 is guided to the inside of a slit 33 thatextends in a longitudinal direction formed at the holding member 18, asshown in FIG. 3, FIG. 4, and FIG. 7, and the movement in the openingdirection of the first and second actuating members 16 and 17 can berestricted.

A curved needle 34 is fixed to a distal end of the first actuatingmember 16. Alternatively, this curved needle 34 may be detachablymounted on the first actuating member 16. A needle eye 5 into which asuture thread 4 can be inserted is formed at a distal end side of thecurved needle 34. In addition, as shown in FIG. 8, the curved needle 34is so small in thickness as to be better punctured into a tissue.

As shown in FIG. 5 to FIG. 8A, the second actuating member 17 hasbifurcated fixing arms 43 and 44. Fixing needles 41 and 42 are fixed todistal ends of these fixing arms 43 and 44, respectively. In the presentinvention, although the fixing needles 41 and 42 are fixed integrally tothe fixing arms 43 and 44, these needles may be removably mounted. Onthe other hand, as shown in FIG. 7, a protect member 45 having holes 46and 47 formed thereat is fixed to the first actuating member 16 byscrews 48 and 49. As shown in FIG. 5 and FIG. 6, this protect member 45covers a needle tip of the fixing needles 41 and 42 each when the firstand second actuating members 16 and 17 are closed. For example, thisprotect member prevents a tissue or the like from being caught by thefixing needles 41 and 42. Alternatively, the protect member 45 may havea structure in which a recess 254 is formed in a first actuating member218 as in the 10th embodiment (see FIG. 68) (to be described later).

As shown in FIG. 5 and FIG. 11, a channel member 35 is fixed to theholding member 18 via an L shaped supporting member 39. This channelmember 35 has: a pipe 36 formed of a comparatively hard member disposedat its distal end portion; and a tube 37 formed of a comparatively softmaterial tightened by a fixing thread 38 after pressed into this pipe.This fixing thread 38 is fixed to the tube 37 by an adhesive. This pipe36 is inserted into a concave portion 52 (refer to FIG. 11) of thesupport member 39, and is fixed to this support member 39 by propermeans such as brazing, soldering, or bonding. This support member 39 isformed of two elongated holes 53 through which screws 50 and 51 canpass, as shown in FIG. 11 and FIG. 13, whereby the support member 39 canbe fixed to the holding member 18 by the screws 50 and 51 so as to makeit possible to adjust a position relevant to the holding member 18.

In addition, as shown in FIG. 10 and FIG. 11, a protect member 54 isfixed to the pipe 36 by proper means such as brazing, soldering, orbonding. This protect member 54 covers a needle tip of the curved needle34 when the first and second actuating members 16 and 17 are closed, andprevents the curved needle 34 from being caught by a tissue or the like.As shown in FIG. 11 and FIG. 13, a thread guide 55 having its axial holethrough which the suture thread 4 can pass is mounted on the supportmember 39. This thread guide 55 is composed of: a pipe 57 formed of arelatively hard material; and a tube 58 formed of a relatively softmaterial. The pipe 57 is fixed to the tube 58 by proper means such aspress-in or bonding, for example. In addition, the pipe 57 is fixed tothe support member 39 by proper means such as brazing, soldering, orbonding.

As shown in FIG. 11 to FIG. 13, like the thread guide 55, a thread guide56 is fixed to the holding member 18 by screws 62 and 63. This threadguide 56 is composed of: a pipe 59 formed of a relatively hard material;a tube 60 formed of a relatively soft material; and a plate shapedsupport member 61. The support member 61 and the pipe 59 are fixed byappropriate means such as brazing, soldering, or bonding.

As shown in FIG. 2, the tube 37 communicates with a base 64 linked withthe operating member main body 77 at its frontal side. A biopsy valve 69is attached to the frontal side of this base 64. In addition, tubes 58and 60 communicate with holes 65 and 66 formed at the operating membermain body 77, respectively, at their frontal side.

In addition to the above described fixing member 40 (refer to FIG. 8),the suturing device 3 according to the present embodiment is fixed atseveral positions to an insert portion 7 of the endoscope 12 by anotherfixing member 70 as shown in FIG. 2. These fixing members 70 as well areremovably formed, whereby the suturing device 3 can be removably mountedon the insert portion 7 of the endoscope 12. Of course, the suturingdevice 3 and the insert portion 7 are formed integrally with each other,whereby they are made removable from each other.

As shown in FIG. 2, FIG. 14, and FIG. 15, a thread-catching-device 68for catching the suture thread 4 comprises: a hook 79 which is movablein an axial direction and rotatable within a flexible tubular member 78formed of a coil or the like; and an operating member 80 of thethread-catching-device for operating the hook 79. The hook 79 advancesand retracts a grip 81 disposed movably via a pipe 83, for example,whereby the hook can be housed in the flexible tubular member 78 or canbe protruded therefrom. The suture thread 4 can slid on this hook 79when it is hooked by the hook 79. In addition, a stopper 82 whichinhibits advancing movement of the grip 81 is engaged in the pipe 83,for example, whereby the hook 79 can be locked so as not to come off theflexible tubular member 78. Such a thread-catching-device 68 is formedto have outer diameter capable of passing through the inside of thechannel 35. Alternatively, a thread-catching-device 524 shown in FIG.15A to FIG. 15C may be used. This thread-catching-device 524 has a hook525 on which the suture thread 4 can slide as in the case with thethread-catching-device 68. In addition, a guide member 526 is so formedas to face the thread-catching-device 524. As shown in FIG. 15C, thecurved needle 34 is caught between the guide member 526 and the hook 525to facilitate catching the suture thread 4 by using the hook 525.

FIG. 16 shows an insert assisting device 84 for inserting the insertportion 7 that includes the suturing device 3 into a body.

The insert assisting device 84 according to the present embodimentcomprises: a flexible tubular member 85 formed in a shape such that itsdistal end can be easily inserted into a body, for example, in a taperedshape; two valves 86 and 87 having circular holes 90 and 91 disposedrespectively at the proximal end side of this flexible tubular member85; and a base 89 which communicates with an axial hole of the flexibletubular member 85. This base 89 can be used to connect an aspirator (notshown) via a tube, for example, if an aspirating function is required.It is preferable that this base 89 be sealed with a cap (not shown) whenit is not used.

As shown in FIG. 19, instead of the above described valves 86 and 87, aplurality of slits 94 are provided around a hole 93, thereby making itpossible to use a valve 92 such that an object having its externaldiameter larger than the hole 93 can pass.

In addition, instead of the insert assisting device 84, an insertassisting device 95 shown in FIG. 20 and FIG. 21 may be used. Thisinsert assisting device 95 comprises: a flexible tubular member 96; aflexible hood member 97 disposed frontally of the flexible tubularmember 96; and a fixing member 98 for fixing this hood member so as tobe almost sealed at the insert portion 7 that includes the suturingdevice 3. This insert assisting device 95 is useful to maintain airtightness in a body. After this insert assisting device 95 has beeninserted into the body, an endoscope is pushed out in a directionindicated by the arrow in FIG. 21, whereby the suturing device 3 fixedto this endoscope can be protruded from the flexible tubular member 96.

In addition, as shown in FIG. 42 and FIG. 43, sealing means 144 may beprovided at the proximal end side of the suturing device 3 and theendoscope 12.

This sealing means 144 comprises: an inner tube 140 having its innerdiameter through which the endoscope 12 can pass; and an outer tube 141having its inner diameter larger than the inner tube 140, the outer tubehaving this inner tube inserted therethrough. The outer diameter of theouter tube 141 is slightly larger than the inner diameter of each of theholes 90 and 91 of the valves 86 and 87. Tubes 37, 58, 60, and 73 andthe like are passed through a space formed between the inner tube 140and the outer tube 141. A sealing member 142 is filled in a spacebetween these tubes. At both ends of the inner tube 140, a space betweenthe tube and the endoscope 12 is sealed by a tape 143. In this manner, aspace between the insert assisting device 84 and the suturing device 3and the endoscope 12 are securely sealed, and air is fed into a body,thereby preventing air leakage when the body is inflated.

Now, suturing procedures using the above described suturing system willbe described here.

(1) The suturing device 3 and the endoscope 12 assembled in a stateshown in FIG. 2 are inserted into the flexible tubular member 85 shownin FIG. 16, and are disposed until a state shown in FIG. 17 has beenobtained. At this time, the suture thread 4 is inserted into the needleeye 5 of the curved needle 34, and each end portion passes through thethread guides 55 and 56 each. Then, the suture thread 4 is held so as tobe pulled out of the suturing device 3 from the holes 65 and 66 of theoperating member main body 77. In addition, the endoscope 12 isconnected to the image processing device 14, the light source device 15and the like (FIG. 1) via a universal code. Then, while the inside ofthe body is observed through the monitor 13, the flexible tubular member85 having the suturing device 3 and the endoscope 12 housed therein isinserted into a required location in the body.

(2) The inside of the body is inflated by using an air feeding functionsuch as an endoscope, thereby providing a space.

(3) As shown in FIG. 18, the endoscope 12 is advanced, whereby thesuturing device 3 is protruded from the flexible tubular member 85.

(4) The suturing device 3 is placed close to the suture site, themovable member 75 shown in FIG. 2 is pushed, and the second actuatingmembers 16 and 17 are opened as shown in FIG. 4.

(5) As shown in FIG. 22, the movable member 75 is operated while thecurved needle 34 and the fixing needles 41 and 42 are pushed against thesuture site. As shown in FIG. 23, the first and second actuating members16 and 17 are closed.

(6) As shown in FIG. 24, the suture thread 4 coming off a tissue ishooked by the hook 79 of the thread-catching-device 68 inserted via thebiopsy valve 69. As shown in FIG. 25, the suture thread 4 is retractedinto the flexible tubular 78 together with the hook 79.

(7) As shown in FIG. 26, the thread-catching-device 68 is pulled outfrom the channel 35 to the outside of the body, and the suture thread 4is pulled out from the biopsy valve 69. At this time, the suture thread4 slides on the hook 79, whereby one end portion of the suture thread 4moves from one of the thread guides 55 and 56 into the channel 35, andis pulled out from the channel 35 to the outside of the body togetherwith the thread-catching-device 68. The other end portion of the suturethread 4 is held so as to be inserted through the other end of thethread guides 55 and 56 each.

(8) As shown in FIG. 27, the movable member 75 is operated, the firstand second actuating members 16 and 17 are opened, and the curved needle34 and the fixing needles 41 and 42 are pulled out from a suture site.

(9) As shown in FIG. 28, the suturing device 3 is retracted again intothe flexible tubular member 85, and the suturing device 3 is pulled outfrom the inside of the cavity together with the flexible tubular member85.

(10) A knot is formed in the suture thread 4 at the outside of the body,and this knot is fed into the body several times by the knot pusher 99as shown in FIG. 29. The knot pusher 99 shown in FIG. 29 has a hoodshaped cylindrical member mounted on a distal end portion of theendoscope, and two holes are provided on a side face of this cylindricalmember. Of course, any knot pusher is available for use without beinglimited to the shown knot pusher 99 as long as it has a structure orform such that a knot can be fed into the body. In addition, forexample, a knot itself such as Grinch knot or Loaders knot may be formedmovably. In this case, the knot can be fed into the body by using propermeans.

(11) Lastly, an endoscope on which the suturing device 3 is not mountedis inserted into an endoscope, and a residual suture thread 4 is cut byusing a scissors forceps or the like.

According to the endoscopic suturing system 1 of the present embodiment,the first and second actuating members 16 and 17 holding the curvedneedle 34 and the fixing needles 41 and 42 are formed integrally withthe first and second arm members 24 and 25 that can be pass through thepins 28 and 29, whereby a large opening/closing angle can be formedbetween the first and second actuating members 16 and 17. In thismanner, even in a size which is small for an endoscope, there can beformed a suturing device having one or a plurality of needles capable ofmoving all over a sufficiently large angle required for a suturingoperation.

In addition, the coils 72 and 76 linked with the holding member 18 thatrotatably supports the first and second actuating members 16 and 17 arerestricted from expansion and contraction by the flexible tube 73. Thus,a large force can be transmitted via the coils 76 and 72. In thismanner, a large force required for a suturing operation can betransmitted to needles 34, 41, and 42 via the coils 76 and 72 and thefirst and second actuating members 16 and 17.

Further, the suturing device 3 is fixed to the insert portion of theendoscope 12, thereby making it easily to do a suturing work by aflexible endoscope that has been very difficult in the prior art.

Furthermore, a minimal invasive suturing procedure can be carried outfor a patient because no open surgical operation is required.

As described above with reference to each of the above embodiments, whenthe tissue is to be sutured, for example, a grasping forceps 152 isinserted into the body through the instrument channel port 6 of theendoscope 12, as shown in FIG. 50. While the tissue is pulled by thisgrasping forceps 152, the first and second actuating members 16 and 17can be closed, and the tissue can be punctured with a curved needle 34.The subsequent procedure is the same as that described with referenceeach of the embodiments.

Second Embodiment

FIG. 30 to FIG. 35 each show an endoscopic suturing system according toa second embodiment of the present invention. A variety of endoscopesdescribed hereinafter are basically similar to those according to theabove described embodiment. Like elements are designated by likereference numerals. A detailed description thereof is omitted here.

As shown in FIG. 30 and FIG. 31, a system according to the presentembodiment comprises a protect member 100 mounted at a distal endportion of the insert portion 7 of the endoscope 12, the protect member100 covering the distal end portion of the suturing device 3. Thisprotect member 100 comprises: a cylindrical fixing portion 104, forexample, that can be removably fixed at a distal end of the insertportion 7; and a movable portion 103 slidably mounted on the outerperiphery of this fixing portion 104. This movable portion 103 ispreferably made of a transparent resin, e.g., polycarbonate, norborneneresin, cycloolefin-based resin, or polyethylene terephthalate.

As shown in FIG. 32 to FIG. 34, at a wall portion of the fixing portion104, there are formed an axial hole 111 and radial holes 113 and 114having this axial hole communicating with a peripheral face at theproximal part of each end portion. In addition, at the outer peripheryof the fixing portion 104, a lock member 106 shown in FIG. 35 is fixedwith screws or the like inserted via mount holes 118 and 119, forexample. This lock member 106 comprises engaging portions 116 and 117which is disposed so as to be almost perpendicular relative to the outerperiphery face of the fixing portion when fixed to the fixing portion104, and an inclined portion 115 which descends gradually toward adistal end from a space between these engagingly fixing portions. Theentirety of the lock member is formed of a resilient material such asmetal or resin. At a position that corresponds to these engagingportions 116 and 117 each, an opening 112 is formed at the outerperiphery face of the fixing section 104. In this manner, when the lockmember is compressed against the outer periphery face of the fixingportion 104, the engaging portions 116 and 117 are housed in the opening112, and the entirety of the lock member 106 is flattened.

On the other hand, the movable portion 103 has: a concave portion 120 adefined at its distal end side on an engaging wall 120 which can beengaged with the engaging portions 116 and 117 of the lock member 106;and a concave portion 108 a communicating with this concave portion 120a, the concave portion being limited at its distal end side on anengaging wall 108. The rear end side of these concave portions 108 a and120 a each is defined by the engaging wall 109. In the concave portion108 a, there are housed an inclined portion 115 of the lock member 106;and a moving member 107 that controls engagement or disengagementbetween this lock member 106 and the engaging wall 120.

The moving member 107 according to the present embodiment is formed of ahard material, for example, in a substantially cylindrical shape or flatshape. It is preferable that its length be formed to be larger than theaxial dimension of the concave portion 120 a and be formed so as to behoused in the concave portion 108 a without compressing the inclinedportion 115 when the engaging portions 116 and 117 and the engaging wall120 are engaged with each other. Transmission members 105 and 121 areextended, respectively, from an end portion of this moving member 107.The transmission member 105 is extended from the concave portion 120 avia a small hole that passes through the engaging wall 109. Thetransmission member 121 is extended to the inner periphery side of themovable portion 103 from a slit 110 that communicates with the concaveportion 108 a, and further, is extended to the outer periphery of thefixing portion via a radial hole 113, an axial hole 111, and a radialhole 114 of the fixing portion 104. These transmission members 105 and121 extend to the operating member main body 77 shown in FIG. 30 andFIG. 31 via a proper flexible tube (not shown), and is connected withoperating member 101 and 102 of the protect member 100.

In this protect member 100, movement in the right side on paper of themovable portion 103 is restricted when an engagingly lock wall formed atthe movable portion 103 as shown in FIG. 32 abuts against the engagingportions 116 and 117 of the lock member 106 fixed to the fixing portion104. In this manner, as shown in FIG. 30, the needle fixed to the distalend portion of the suturing device is covered with the movable section103, and is free of being exposed to the outside.

If the operating member 101 of the protect member 100 connected to thetransmission member 105 is pulled in this state, the moving member 107moves in the right direction, as shown in FIG. 33. At this time, themoving member 107 rolls over the inclined portion 115 of the lock member106, and thus, the engaging portions 116 and 117 are housed in theopening 112, and are disengaged from the engaging wall 120. The movableportion 103 can move to the rear end side, i.e., to the right side shownin the figure. Further, when the operating member 101 of the protectmember 100 is pulled, the moving member 107 abuts against the engagingwall 109, as shown in FIG. 34, and the movable portion 103 moves to theright side together with the moving member 107 and enters a state shownin FIG. 31. At this time, the lock member 106 abuts against the innerperiphery face at both sides of the slit 110 formed at the movableportion 103. In contrast, if the operating member 102 of the protectmember 100 connected to the frontal side of the transmission member 121is pulled, the movable member 107 moves to the left side, and is engagedwith the engaging wall 108. Then, the movable portion 103 moves to theleft side together with the moving member 107. If the engaging wall 120exceeds the opening 112, the lock member 106 returns to a state shown inFIG. 32 by its resilience. Then, the engaging portions 116 and 117 areprotruded again from the outer periphery face of the fixing portion 104,whereby the movement in the left direction of the movable portion 103can be restricted.

Now, the suturing procedure using the above described suturing systemwill be described here.

(1) The above described protect member 100 is mounted on the suturingdevice and endoscope assembled as in the above described embodiment, andthen, the operation member 102 of the protect member 100 is pulled. Inthis manner, the moving portion 103 is protruded at its distal end sideand comes into a state shown in FIG. 30. In this state, the movingportion is inserted into the body while the inside of the body isobserved through the endoscope 12.

(2) After insertion into the body, the operating member 101 of theprotect member 100 is pulled, and the moving portion 103 is retracted toenter a state shown in FIG. 31. In this manner, a distal end portion ofthe suturing device 3 is exposed so that a suturing operation can becarried out by using a procedure similar to that according to the firstembodiment.

(3) After suturing has been completed, the moving portion 103 isprotruded in a state shown in FIG. 30 by pulling the operating member102 of the protect member 100. In this state, the suturing device andendoscope is removed from the body.

In the present embodiment, the moving portion 103 of the protect member100 moves in an axial direction. Thus, the outer diameter of the devicecan be reduced in addition to advantageous effect of the firstembodiment. Furthermore, operation can be simplified.

Third Embodiment

FIG. 36 shows a protect member 122 used for an endoscopic suturingsystem according to a third embodiment of the present invention.

The protect member 122 according to the present embodiment comprises: afixing portion 124 fixed to a distal end portion of an insert portion 7;and a movable portion 123 that can slide on this fixing portion 124. Anexternally sealed annular space 128 is formed between these fixingportion and movable portion. A base 125 communicating with the annularspace 128 is mounted at the outer periphery of the movable portion 123,a fluid 127 can be poured into or discharged from the annular space 128.This fluid 27 may be liquid or gas.

In the present embodiment, at the protect member 122, for example, whenthe suitable fluid 127 such as physiological saline, water, or air isfilled in a fluid pouring device (not shown) such as syringe, and thisfluid is poured into the annular space 128, the movable portion 123slides to the right side on paper. In contrast, the fluid 127 isdischarged from the annular space 128 by setting a fluid pouring device129 to a negative pressure, the movable portion 123 can slide to theleft side.

Advantageous effect similar to each of the above described embodimentsis provided by using this protect member 122.

Fourth Embodiment

FIG. 37 to FIG. 41 each show an endoscopic suturing system according toa fourth embodiment of the present invention.

As shown in FIG. 37, in the present embodiment, a needle holder 132 isfixed to a first actuating member 16 of a suturing device 3, and aremovable needle 131 is removably connected to a distal end of theneedle holder 132. This removable needle 131 has a shaft portion 138,and one end of a suture thread 130 is fixed to a distal end of the shaftportion 138. The needle holder 132 has a groove 137 opened along almostall the full length at the inner periphery side, as shown in FIG. 41,and the suture thread 130 is removably extended inside of the groove137.

On the other hand, the other end of this suture thread 130 extends tothe frontal vicinity of the endoscope through thread lock means 135formed at a needle thread fixing device 133. This thread lock means 135is formed so that the suture thread 130 can be moved arbitrarily in adirection indicated by the arrow B, i.e., in a direction in which thesuture thread is retracted. In contrast, the lock means 135 is formed sothat the suture thread cannot be moved in a direction indicated by thearrow A, i.e., in a direction in which the suture thread is advanced.

Further, as shown in FIG. 38, needle lock means 134 capable of engaginga removable needle 131 as well is formed at the needle thread fixingdevice 133. It is preferable that this needle lock means 134 be formedof a resilient member or the like. In the present embodiment, thisneedle thread fixing device 133 is removably mounted on a distal end ofa needle fixing device main body 139. This needle thread fixing devicemain body 139 can be inserted into a body via a suitable channel 35. Inaddition, although the needle thread fixing device 133 is engaged bybeing pressed into the needle thread fixing device main body 139, thefixing device can be fixed to be grasped by a suitable device such as agrasping forceps, for example.

In this case, the removable needle 131 and needle thread fixing device133 described above are at least partly made of a biocompatible metalsuch as stainless steel, pure titanium or titanium alloy, abiocompatible resin such as polyimide, poly(etheretherketone) (PEEK),polysulfon, liquid crystal polymer, or polyamide, a biocompatibleceramic material such as alumina, silicon nitride, or the like. As inthe first embodiment, the suture thread 130 is formed like amonofilament line or stranded wire by using a material such as nylon,polyester, silk, fluoroplastic or bioabsorbable resin.

This endoscopic suturing system can be used as follows.

(1) The suturing device 3 is inserted into a body while its distal endportion is protected by the insert assisting devices 84 and 95 accordingto the first embodiment described above; a protect member 100 accordingto the second embodiment; or alternatively, a protect member 122 or thelike according to the third embodiment. The inside of the body can beobserved through the endoscope 12 as in the above described embodiment.

(2) During suturing, the first actuating member 16 and the secondactuating member 17 are closed so as to press the removable needle 131and the fixing needles 41 and 42 against a suture site, and theremovable needle 131 is punctured into a tissue.

(3) As shown in FIG. 38, the removable needle 131 after punctured isprotruded from the tissue. Thereafter, the removable needle 131 isinserted into the needle lock means 134 of the needle thread fixingdevice 133 by pushing out the needle fixing device main body 139 towardthe front end side, and is latched thereby.

(4) When the first actuating member 16 and the second actuating member17 are opened, the removable needle 131 is latched by the needle lockmeans 134. Thus, the removable needle 131 is removed from the needleholder 132, and the suture thread 130 is removed from the groove 137 ofthe needle holder 132. In this manner, as shown in FIG. 39, the suturethread 130 remains in the tissue while a portion between the needlethread fixing device 133 and thread lock means 135 forms a loop.

(5) As shown in FIG. 39, the needle thread fixing main body 139 isadvanced toward the tissue while an end portion of the suture thread 130disposed at the outside of the body is pulled frontally. In this manner,a loop of the suture thread 130 is contracted, and the tissue is tieduntil a state shown in FIG. 40 has been obtained.

(6) Lastly, a redundant suture thread 130 is cut by a thread cuttingdevice 136. The needle thread fixing device 133 left in the body can beremoved during thread removal.

According to the system of the present embodiment, in addition toadvantages according to the above described first and secondembodiments, there is no need for making a knot outside of the body, andfeeding the knot into the body. This makes it possible to reduce anoperation time, and further, facilitate procedures. In addition, thetied state of the tissue can be easily adjusted.

Fifth Embodiment

FIG. 44 and FIG. 45 each show a fifth embodiment of the presentinvention. This fifth embodiment is basically similar to theabove-described fourth embodiment, and is different therefrom in thepoint below.

As shown in FIG. 44, the needle thread fixing device 133 according tothe present embodiment is removable mounted on a holding member 145formed at the second actuating member 17.

The needle thread fixing device 133 described above are at least partlymade of a biocompatible metal such as stainless steel, pure titanium ortitanium alloy, a biocompatible resin such as polyimide,poly(etheretherketone) (PEEK), polysulfon, liquid crystal polymer, orpolyamide, a biocompatible ceramic material such as alumina, siliconnitride, or the like.

This endoscopic suturing system can be used as follows.

(1) When the suturing device 3 is inserted into a body, its distal endportion is particularly protected by the insert assisting devices 84 and95, protect member 100, protect member 122 or the like according to theabove described embodiment, for example. The needle thread fixing device133 is mounted on the second actuating member 17, thus making itunnecessary to use a thread fixing device main body 139 or an ordinarygrasping forceps and the like, for example.

(2) During suturing, as in the fourth embodiment, the first actuatingmember 16 and the second actuating member 17 are closed so as to pressthe removable needle 131 and fixing needles 41 and 42 against a suturesite, and the removable needle 131 is punctured into a tissue.

(3) As shown in FIG. 45, the removable needle 131 protruded from atissue after punctured is inserted into the needle lock means 134 of theneedle thread fixing device 133 held at the holding member 145, and isengaged therewith.

(4) When the proximal end side of the suture thread 130 is pulled, thetissue is tied because one end of the suture thread 130 is fixed to theremovable needle 131, and the groove 137 of the needle holder 132 isopened at the inner periphery side.

(5) When the first actuating member 16 and the second actuating member17 are opened, the removable needle 131 is engaged with the needle lockmeans 134. Thus, the removable needle 131 and the needle thread fixingdevice 133 are removed from the holding member 145 to enter a stateshown in FIG. 40.

(6) Lastly, a redundant suture thread 130 is cut by the thread cuttingdevice 136.

In the present invention, advantages similar to those according to thefourth embodiment are obtained. Further, in the present embodiment,there is no need for holding the needle thread fixing device 133 solely,and thus, the suturing operation is further facilitated.

Sixth Embodiment

FIG. 46 to FIG. 49 each show a sixth embodiment. The sixth embodiment aswell is basically similar to the fourth embodiment, and is differenttherefrom in the point below.

As shown in FIG. 46, in the present embodiment, four engagingly lockmembers 146 for holding at least one loop formed in advance at thesuture thread 130 made of the same material as that in the firstembodiment are provided at the second actuating member 17. Theseengagingly lock members 146 are formed of a resilient element in a clawshape, and is fixed so that two of these lock members are opposed to theremaining two members at a site opposed to the first actuating member16. A part of the suture thread 130 is hooked by these engagingly lockmembers 146, and two large loops 148, for example, are formed. Theremovable needle 131 can pass through the inside of these large loops148. Further, at least one loop 149 for forming a knot described lateris formed at the periphery of the suture thread 130 that forms the largeloop 148 and a knot like a pre-knot 232 shown in, for example, FIG. 89(to be described later) is formed.

A needle fixing device 150 comprises: needle fixing means 147 capable ofbeing engaged with the removable needle 131; and a tubular member 151 towhich this needle fixing mans is fixed. This needle fixing device 150 isformed so that the device can be inserted into a suitable channel 35.Alternatively, the needle fixing device 150 may be fixed onto thesuturing device 3. In this case, a position at which the needle fixingdevice 150 corresponds to a position at which the removable needle 131can be engaged with the needle fixing means 147.

This endoscopic suturing system can be used as follows.

(1) When the suturing device 3 is inserted into a body, as in the abovedescribed embodiment, the device is protected by the above describedinsert assisting devices 84 and 95, protect member 100, a protect member122 or the like, for example.

(2) When the removable needle 131 is punctured into a tissue, the firstactuating member 16 and the second actuating member 17 are closed so asto press the removable needle 131 and the fixing needles 41 and 42against a suture site.

(3) As shown in FIG. 47, the removable needle 131 after punctured isprotruded from the tissue. Thereafter, the tubular member 151 is pushedout toward the front end side, the removable needle 131 is inserted intothe needle lock means 147 of the needle thread fixing device 150 held onthe tubular member 151, and is latched thereby.

(4) As shown in FIG. 48, when the first actuating member 16 and thesecond actuating member 17 are opened, the removable needle 131 isengaged with the needle engagingly lock means 147. Thus, the removableneedle 131 is removed from the needle holder 132, and a large loop 148is removed from the engagingly lock member 146. In this manner, a smallloop 149 forms a knot on a suture thread 130 in corporation with thelarge loop.

(5) Then, as shown in FIG. 49, the proximal end side of the suturethread 130 and the needle fixing device 150 are pulled, the knot 149 istied, and an injury is sutured.

(6) Lastly, as shown in FIG. 49, a redundant suture thread 130 is cut bya thread cutting device 136.

This system according to the sixth embodiment provides advantages thatare similar to those according to the above described fourth embodiment.In addition, there is no need for keeping any member except the suturethread 130 in the body.

As has been described with respect to each of the above describedembodiments, when a tissue is sutured, a grasping forceps 152, forexample, can be inserted into a body through the instrument channel port6 of the endoscope 12 as shown in FIG. 50. While the tissue is pulled bythis grasping forceps 152, the first and second actuating members 16 and17 are closed, thereby making it possible to puncture the removableneedle 131 into the tissue. The subsequent procedure is similar to thatdescribed with respect to the respective embodiments.

Seventh Embodiment

FIG. 51 to FIG. 56 each show a seventh embodiment of the presentinvention. In this system, a structure of the suturing device 3 isdifferent from that according to the above described fourth embodiment.Further, a needle thread fixing device 153 is disposed instead of theneedle thread fixing device 133 in the above described embodiment.

As shown in FIG. 51, the needle thread fixing device 153 comprisesthread lock means 155 and needle lock means 154. This thread lock means155 is composed of a resilient tubular member having its small axialhole, and the suture thread 156 is inserted into this axial hole so asto be pressed into the hole. In this manner, the thread lock means 155can engagingly lock the suture thread 156 at an arbitrary position. Thisthread lock means 155 can be formed of a silicon tube or the like, forexample. On the other hand, in the case where sufficient strength cannotbe obtained by a silicon tube which is easily broken after ligation, forexample, a reinforce member 200 such as a PTFE resin based tube may bedisposed coaxially of the thread lock means 155, as shown in FIG. 54.

In addition, the thread lock means 155 may be modified into a threadlock means 565 as shown in FIG. 54A. The thread lock means 565 iscomprised of an elastic member 566 and tubular member 567. The tubularmember 567 is arranged on the outer surface of the elastic member 566and has at least one recess formed by an outer force to increase thesliding resistance between the thread 156 and the elastic member 566.This makes it possible to increase the tying force in a suturingoperation. FIG. 54B to FIG. 54D show arrangements in which the tubularmember 567 are deformed in different manners. FIG. 54B shows anarrangement in which a plurality of recesses are formed in the tubularmember 567 in the longitudinal direction. FIG. 54C shows an arrangementin which a recess is formed in a direction perpendicular to thelongitudinal direction of the tubular member 567. FIG. 54D shows anarrangement in which the tubular member 567 is swaged to uniformly andradially apply a pressure to the elastic member 566.

For the suture thread 156, a loop portion 158 is formed at the proximalend of the suture thread 156. This loop portion 158 is removably engagedwith an engaging portion 163. This engaging portion 163 is fixed to atransmission member 165, and is arranged retractably in a coil 164. Theproximal end portion of the transmission member 165 is linked with anoperating member (not shown) which is operable at the outside of thebody. This operating member is advanced or retracted, whereby theengaging portion 163 can be advanced or retracted along the coil 164. Inaddition, a channel 160 through which the coil 164 is inserted has aflexible tubular member 162 and a receiving portion 161 fixed to adistal end thereof. A needle thread fixing device 153 is held via thisreceiving portion 161.

As shown in FIG. 53, an inclined portion 167 is formed at needle lockmeans 154. In addition, an inclined portion 169 is formed similarly at aremovable needle 157 as well. Thus, the needle lock means 154 and theremovable needle 157 are hardly removed from each other while they areengaged with each other via these inclined portions 167 and 169. Inaddition, in the present embodiment, there is provided a through hole170 opened on a tapered face at a distal end through an axial portion ofthe removable needle 157. This through hole 170 is formed to have astepped structure. As shown in FIG. 53, for example, a knot 166 formedat the other end of the suture thread 156 is housed in this through hole170, and this knot 166 can be engaged at a stepped portion so as not tomove to the other end side. For this suture thread 156, this knot 166can be fixed to the removable needle 157 by a suitable bonding agent. Inaddition, a groove 168 similar to that shown in FIG. 41 is formed at aneedle holder 159 that holds this removable needle 157, a groove 168similar to that shown in FIG. 41 is formed, and a suture thread 156 canbe removed from the needle holder 159.

The removable needle 157 and needle thread fixing device 153 describedabove are at least partly made of a biocompatible metal such asstainless steel, pure titanium or titanium alloy, a biocompatible resinsuch as polyimide, poly(etheretherketone) (PEEK), polysulfon, liquidcrystal polymer, or polyamide, a biocompatible ceramic material such asalumina, silicon nitride, or the like. As in the first embodiment, thesuture thread 156 is formed like a monofilament line or stranded wire byusing a material such as nylon, polyester, silk, fluoroplastic orbioabsorbable resin.

This endoscope suture system can be used as follows.

(1) When the suturing device 3 is inserted into a body, the suturingdevice 3 is inserted while its distal end portion is particularlyprotected as in the above described embodiment.

(2) The first actuating member 16 and the second actuating member 17 areclosed so as to press the removable needle 157 and the fixing needles 41and 42 against a suture site, and the removable needle 157 is puncturedinto a tissue. Of course, this operation can be observed through theendoscope 12.

(3) As shown in FIG. 52, the needle 157 protrudes from a tissue. Then,the coil 164 is pushed out to the forward side, the removable needle 157is inserted into needle lock means 154 of the needle thread fixingdevice 153, and is latched therewith.

(4) When the first actuating member 16 and the second actuating member17 are opened, the removable needle 157 is engaged with the needle lockmeans 154. Thus, the removable needle 157 is removed from the needleholder 159 to enter a state shown in FIG. 55.

(5) A transmission member 165 is pulled to the proximal end side by anoperating member (not shown), and a tissue is tied until a state shownin FIG. 56 has been obtained. Then, a distal end portion of thetransmission member 165 is protruded from the coil 164, and the loopportion 158 is removed from the engaging portion 163.

(6) Lastly, a redundant thread 156 is cut by a thread cutting device136.

This system according to the seventh embodiment as well providesadvantages similar to those according to the above described fourthembodiment. Further, in the present embodiment, a length of the suturethread 156 may be short. Thus, a suturing operation is furtherfacilitated.

Eighth Embodiment Embodiment

FIG. 57 to FIG. 63 each show an endoscopic suturing system according toan eighth embodiment of the present invention.

As shown in FIG. 57, a needle thread fixing device 171 is removablyattached to a second actuating member 17 instead of the holding member145 according to the fifth embodiment (refer to FIG. 44). Needle fixingmeans 177 is formed at the needle thread fixing device 171. One end of asuture thread 172 is fixed to this needle thread fixing device 171. Inaddition, the other end of this suture thread is extended into a coil164 via thread lock means 173 similar to that according to the seventhembodiment, and a loop section 174 is formed.

A needle holder 178 that holds the removable needle 175 at its distalend portion is fixed to a first actuating member 16. One end of theother suture thread 176 is fixed to this removable needle 175, the otherend of this suture thread as well is extended in the coil 164 via threadlock means 173, and a loop portion 174 is formed. These loop portions174 are engaged with an engaging portion 163 of a transmission member165 as in the seventh embodiment.

A suturing operation using this endoscope system is carried out asfollows.

(1) As in the above described embodiments each, the suturing device 3 isinserted into a body while its distal end portion is particularlyprotected by the insert assisting devices 84 and 95, protecting member100, protect member 122 or the like.

(2) As shown in FIG. 58, the first and second actuating members 16 and17 are closed so as to press the removable needle 175 and the fixingarms 41 and 42 against a suture site, and the removable needle 175 ispunctured into a tissue.

(3) As shown in FIG. 58, the removable needle 175 after punctured isinserted into needle fixing means 177 of the needle thread fixing device171 held at a predetermined position, and is engaged therewith.

(4) As shown in FIG. 59, when the first and second actuating members 16and 17 are opened, the needle fixing device 171 is removed from thesecond actuating member 17 while the removable needle 175 is engagedwith the needle fixing device 171.

(5) The transmission member 165 is pulled by an operating member (notshown) in a state shown in FIG. 60, a tissue is tied by the suturethread 176 until a state shown in FIG. 61 has been obtained. Then, asshown in FIG. 62, a distal end portion of the transmission member 165 ispushed out from the coil 164. The loop portion 174 is removed from theengaging portion 163 of the transmission member. Only the loop portion174 of one suture thread can be pulled if necessary.

The removable needle 157 and needle thread fixing device 171 describedabove are at least partly made of a biocompatible metal such asstainless steel, pure titanium or titanium alloy, a biocompatible resinsuch as polyimide, poly(etheretherketone) (PEEK), polysulfon, liquidcrystal polymer, or polyamide, a biocompatible ceramic material such asalumina, silicon nitride, or the like. As in the first embodiment, thesuture thread 172 is formed like a monofilament line or stranded wire byusing a material such as nylon, polyester, silk, fluoroplastic orbioabsorbable resin.

(6) Lastly, as shown in FIG. 63, redundant suture threads 172 and 176are cut by the thread cutting device 136.

This system according to the eighth embodiment as well providesadvantages similar to the above described fourth embodiment. Further, inthe present embodiment as well, a length of the suture threads 172 and176 each may be short. Thus, a suturing operation is furtherfacilitated.

Ninth Embodiment

FIG. 64 to FIG. 66 each show an endoscopic suturing system according toa ninth embodiment of the present invention. The ninth embodiment isdifferent from the eighth embodiment in the point below.

As shown in FIG. 64, in the present embodiment, a first actuating member190 is disposed at needle holders 179 and 180 each mounting removableneedles 184 and 185 each. A groove opened inwardly is extended at theseneedle holders 179 and 180 each, as shown in FIG. 41. In addition, oneof the suture threads 186 and 187 each is fixed to the two removableneedles 184 and 185 each in a manner similar to the seventh embodiment.

A needle fixing device 181 is removably mounted on the second actuatingmember 191. Needle lock means 182 and 182 for engaging the removableneedles 184 and 185 are formed at the needle fixing device 181.

As shown in FIG. 65, the other ends of the suture threads 186 and 187are extended into the coil 164 via thread lock means 188 similar to thethread lock means 155 according to the seventh embodiment, and a loopportion 189 is formed. This loop portion 189 as well is engaged with theengaging portion 163 of the transmission member 165 as in the seventhembodiment.

The removable needles 184 and 185 and needle thread fixing device 181described above are at least partly made of a biocompatible metal suchas stainless steel, pure titanium or titanium alloy, a biocompatibleresin such as polyimide, poly(etheretherketone) (PEEK), polysulfon,liquid crystal polymer, or polyamide, a biocompatible ceramic materialsuch as alumina, silicon nitride, or the like. As in the firstembodiment, the suture threads 186 and 187 are formed like amonofilament line or stranded wire by using a material such as nylon,polyester, silk, fluoroplastic or bioabsorbable resin.

A suturing operation using this endoscope system is carried out asfollows.

(1) As in the above described embodiments each, the suturing device 3 isinserted into a body while its distal end portion is protected by theinsert assisting devices 84 and 95, protect member 100, protect member122 or the like as in the above described embodiments each.

(2) The first and second actuating members 190 and 191 are closed so asto press the needle lock means 182 and 183 and the removable needles 184and 185 against a suture site, and the removable needles 184 and 185 arepunctured into a tissue.

(3) As shown in FIG. 65, the removable needles 184 and 185 afterpunctured is inserted into the needle lock means 182 and 183 of theneedle fixing device 181 held at a predetermined position, and isengaged therewith.

(4) When the first and second actuating members 190 and 191 are opened,the removable needles 184 and 185 are engaged with the needle fixingdevice 181. Thus, the removable needle 184 and 185 are removed from theneedle holders 179 and 180. In addition, the needle fixing device 181 aswell is removed from the second actuating member 191. In this manner, astate shown in FIG. 65 is obtained.

(5) Then, as in the seventh embodiment, thread lock means 188 is pushedagainst a tissue, an engaging portion 163 is pulled via the transmissionmember 165, and the tissue is tied. Then, the engaging portion 163 ispushed out from the coil 164, and the loop portion 189 is removed.

(6) Lastly, redundant suture threads 186 and 187 are cut by the threadcutting device 136 as in the fourth embodiment.

On the other hand, as shown in FIG. 66, the tying force may be adjustedwith a length of one suture thread 192 instead of the two suture threads186 and 187. In this case, measures such as thread lock means 188, theengaging portion 163, the coil 164, the transmission member 165, theloop portion 189 and the like become unnecessary.

This system according to the ninth embodiment as well providesadvantages similar to the above described fourth embodiment. Further, inthe present embodiment, the two suture threads 186 and 187 can besutured at the same time by the two removable needles 184 and 185.

10th Embodiment

FIG. 67 to FIG. 99 show the 10th embodiment.

(Arrangement)

The 10th embodiment differs from the first to third embodiments in thefollowing points.

The embodiment uses a pre-knot cartridge 365 like the one shown in FIG.76, FIG. 86, and FIG. 87. This pre-knot cartridge 365 is comprised of aremovable needle 213, suture thread 214, needle-catching-device 212,flexible tubular member 215, and the like. The suture thread 214 isinserted into a hole 366 of the removable needle 213 and has a stopper272 at its distal end face so as not to come off the removable needle213. In this embodiment, an end face of a thread is rounded by heat. Tofix the thread to the removal needle more firmly, a peripheral portionof the stopper 272 may be coated with an adhesive or the hole 366 may becaulked. Before the end face of the thread is rounded by heat, a knotmay be formed at the end face of the thread and thermally molded by amold which can be divided into two parts and forms a spherical surface.In addition, as shown in FIG. 69, FIG. 76, and FIG. 89, a pre-knot 232is formed in the suture thread 214 on the surface of theneedle-catching-device 212. The pre-knot 232 is preferably tied in theform of a Roeder knot as shown in FIG. 89, which can slide. The suturethread 214 is also slidably inserted into the flexible tubular member215. The suture thread 214 is formed into a loop 273 on the proximal endside. As shown in FIG. 86 and FIG. 87, the pre-knot 232 is pressed by acover 274 so as not to come off the needle-catching-device 212 beforethe use of the pre-knot cartridge 365.

As shown in FIG. 69, a needle-catching-sheath 211 is comprised of adistal tip 249, a flexible tubular member 247, a flexible rod 248inserted into the inner hole of the flexible tubular member 247, and thelike. A female screw 250 is formed on the distal tip 249. The flexiblerod 248 is fixed to the other end of the distal tip 249. The flexiblerod 248 prevents the expansion of the flexible tubular member 247 uponapplication of a force.

In place of the needle-catching-sheath 211, a needle-catching-sheath 527like the one shown in FIG. 99 may be used. The needle-catching-sheath527 is comprised of a distal tip 528, a flexible tubular member 529(made of, for example, a flat coil), a connecting member 530 whichconnects the flexible tubular member 529 to the flexible tubular member531, a connecting member 532 connected to a handle 533 on the proximalend side of the flexible tubular member 531, a buckling preventing means536 that partly covers the flexible tubular member 531 and connectingmember 532 by thermal contraction, a stylet 534 for preventing theelongation of the flexible tubular member 529 and flexible tubularmember 531 having both ends connected to the distal tip 528 andconnecting member 532, a flexible tubular body 535 (e.g., a tube made offluoroplastic) fitted on the outer surface of the flexible tubularmember 529 by thermal contraction, and the like.

Unlike the needle-catching-sheath 211, the needle-catching-sheath 527has the flexible tubular body 535. Even if, therefore, a suturingoperation to be described later (FIG. 90 to FIG. 98) is performed afterthe pre-knot 232 is placed on the flexible tubular body 535, the threadis not caught between windings forming the flexible tubular member 529.In addition, since the flexible tubular body 535 allows the thread toslide more smoothly than a coil, it facilitates removing the pre-knot232 from the needle-catching-sheath as shown in FIG. 94 and FIG. 95.

As shown in FIG. 69, a channel member 367 is comprised of a distal pipe233, a tube. 245 fixed to the distal pipe 233, and the like, and fixedto a holding member 223 through a support member 234. Holes 368 and 369having different diameters are formed in the distal pipe 233. Thediameter of the hole 369 is designed to be slightly larger than theouter diameters of the needle-catching-sheath 211 andneedle-catching-device 212 and smaller than the outer diameter of thepre-knot 232. The needle-catching-sheath 211 is inserted into the distalpipe 233 through the inner hole of the channel member 367 having almostthe same diameter as that of the hole 369. The needle-catching-sheath211 as a constituent element of the pre-knot cartridge 365 is detachablyconnected to the distal end of the needle-catching-sheath 211 withscrews. The needle-catching-device 212 is detachably connected to thedistal tip 249 with screws and loaded into the hole 368. The removableneedle 213 of the pre-knot cartridge 365 is detachably fixed to a needleholder 216, as shown in FIG. 69. The suture thread 214 is placed in agroove 217 formed in the needle holder 216.

As shown in FIG. 173 and FIG. 174, a slit 537 may be formed in theneedle holder 216. The formation of such a slit gives elasticity to thefitting portion between the needle holder 216 and the removable needle213, thereby forming a press-fitting structure that prevents theremovable needle 213 from easily coming off the needle holder 216. Asshown in FIG. 69 to FIGS. 77 and 80, the needle-catching-device 212 iscomprised of a needle-catching-body 275, inserting member 276, andspring 277.

As shown in FIG. 78, when the needle-catching-sheath 211 is moved to theleft on the drawing surface, the removable needle 213 is inserted intoan infundibular recess part 278 of the inserting member 276 and spreadsthe spring 277 (see FIG. 88). When the needle-catching-sheath 211 isfurther moved, the spring 277 returns to its original shape and comesinto contact with a contact face 370 formed on the removable needle 213,as shown in FIG. 79. This makes it possible to lock the removable needle213 to the needle-catching-device 212, as shown in FIG. 80.

The needle holder 216 has a taper 253 to reduce the resistance producedwhen it punctures the tissue.

As shown in FIG. 74 and FIG. 75, an operating section 255 of thesuturing device is arranged on the proximal end side of flexible tubularmembers 225 and 226 and transmission member 224. The operating section255 incorporates a ratchet mechanism. When a button 261 is pressed asshown in FIG. 74, the ratchet mechanism is released to allow a slider257 to be freely pushed and pulled. When the button 261 is slid to theright side on the drawing surface, a stopper 267 formed on the button261 is unlocked from an engage part 268 formed on the slider 257, and anengage part 262 that has been biased by a spring 263 is presseddownward. As a consequence, the engage part 262 engages with a burrmember 260 formed in an operating section body 256. The slider 257 canmove only to the right. This inhibits first and second active members218 and 219 from moving in a direction to open.

On the other hand, as shown in FIG. 69, the flexible tubular member 215of the pre-knot cartridge 365 is pressed into a recess 241 of a holder240 fixed to the tube 245. In this case, since the flexible tubularmember 215 is formed from a flexible resin member such as a siliconemember, the suture thread 214 can slide with respect to the flexibletubular member 215 even while the flexible tubular member 215 is pressedin the recess 241.

The structures of the needle-catching-device 212, removable needle 213,and needle holder 216 in this embodiment may be changed into those shownin FIG. 81 to FIG. 85.

As shown in FIG. 81 and FIG. 88, a needle-catching-device 283 iscomprised of a needle-catching-body 279, inserting member 280, spring281, and the like. As shown in FIG. 81, when the needle-catching-device283 is moved to the left on the drawing surface, a removable needle 364is inserted into an infundibular recess part 282 of the inserting member280 and spreads the spring 281 (see FIG. 88). When theneedle-catching-device 283 is further moved, the spring 281 returns toits original shape, as shown in FIG. 83. As a consequence, the spring281 engages with a recess 371 formed in at least part of the removableneedle 364. When the needle-catching-device 283 is moved to the right onthe drawing surface thereafter as shown in FIG. 84, the spring 281including the removable needle 364 moves until it comes into contactwith a contact face 372 formed on the inserting member 280. As a result,the movement of the spring 281 in a direction to spread is restricted bythe wall of an engage part 285 formed on the inserting member 280, andhence the removable needle 364 can be locked to theneedle-catching-device 283.

The removable needle 364 has the recess part 371 to reduce theresistance produced when it punctures the tissue. As shown in FIG. 175and FIG. 176, a slit 538 may be formed in the needle holder 216 withoutthe taper 253 to form a press-fitting structure in which the fittingbetween the removable needle 364 and the needle holder 216 is not easilyreleased.

(Function)

A suturing procedure will be described with reference to FIG. 90 to FIG.97.

(1) A suturing device 210 protected by the insert assisting devices 84and 95 in the first embodiment, the protect member 100 in the secondembodiment, or the protect member 122 in the third embodiment isinserted into the body.

(2) As shown in FIG. 90 and FIG. 91, the removable needle 213 and twofixing needles 229 are so pressed against the region to be sutured as toclose the first and second active members 218 and 219, and the tissue ispunctured with the removable needle 213.

(3) As shown in FIG. 92, after puncturing, the needle-catching-sheath211 is pushed into the removable needle 213, and theneedle-catching-device 212 is engaged with the removable needle 213.

(4) As shown in FIG. 93, the needle-catching-sheath 211 is pulled, andthe removable needle 213 is withdrawn from the needle holder 216.

(5) As shown in FIG. 94, the first and second active members 218 and 219are opened to withdraw the needle holder 216 from the tissue.

(6) As shown in FIG. 95, the needle-catching-sheath 211 is furtherpulled to remove the pre-knot 232 from the needle-catching-device 212.

(7) As shown in FIG. 96 and FIG. 97, the needle-catching-sheath 211 isfurther pulled to move the pre-knot 232 to the opening portion of thetissue, and the opening portion is sutured.

(8) As shown in FIG. 98, a redundant portion of the thread is cut byusing a thread cutting device 136 or the like.

(Effects)

In addition to the advantages of the first and second embodimentsdescribed above, according to this embodiment, since there is no need tomake a knot outside the body and feed it into the body, the manualoperation time can be shortened, and the procedure is furtherfacilitated. In addition, there is no need to indwell any member otherthan the suture thread in the body.

11th Embodiment

FIG. 100 to FIG. 111 show the 11th embodiment.

(Arrangement)

The 11th embodiment differs from the 10th embodiment in the followingpoints.

As shown in FIG. 101, the interval between pins 303 and 304 of asuturing device 373 of the 11th embodiment is larger than that betweenthe pins 235 and 236 in the 10th embodiment. In addition, the intervalbetween the pin 303 and a pin 305, the interval between the pin 304 anda pin 306, the interval between the pin 305 and a pin 307, and theinterval between the pin 306 and the pin 307 are larger than those inthe 10th embodiment. As shown in FIG. 108, this arrangement allows afirst actuating member 287 to make a larger rotational movement than thefirst active member 218 (see FIG. 90) in the 10th embodiment, and alsocan increase the puncturing force acting on a removable needle 213 fixedto a needle holding member 310.

As shown in FIG. 102 and FIG. 106, a second active member 288 can rotateabout the pin 304. A pipe 375 is rotatably fitted on part of the pin304, and a spring 308 is arranged around them. An arm member 376 of thespring 308 is in contact with a contact face 378 formed on the secondactive member 288. As shown in FIG. 107, a force charging member 300 isconnected, through the pin 306, to a second connecting member 290 whichis connected to a rod 291 to be rotatable about the pin 307. This forcecharging member 300 can pivot about the pin 304. The other arm member377 of the spring 308 is so arranged as to come into contact with a ringmember 311 pivotally mounted on a cylinder part 379 of the forcecharging member 300 formed on the axis of the pin 306. In this case, thering member 311 is arranged to reduce the resistance of the arm member377. Obviously, however, this ring member 311 can be omitted. As in the10th embodiment, two fixing needles 298 are mounted on a U-shaped endportion of the second active member 288. As shown in FIG. 177, thesefixing needles 298 may be needles in the form of eagle's claw with itsdistal end curving inward. When the tissue is punctured with a fixingneedle having such a form, the needle does not easily slip off from thetissue. Such a modification of the fixing needle can also be applied toother embodiments.

As shown in FIG. 101, a stopper 309 is fixed to the second active member288 to prevent the second active member 288 from further rotatingclockwise from the state shown in FIG. 101.

Since a pre-knot cartridge 365, a needle-catching-sheath 211, and anoperating section 255 in addition to the removable needle 213, which areother constituent members, are the same as those in the 10th embodiment,a description thereof will be omitted. In addition, this embodiment mayuse the arrangement of the removable needle 364 andneedle-catching-device 283 in described in the 10th embodiment.

(Function)

The operation of the suturing device 373 in a case wherein the tissue tobe sutured is punctured will be described with reference FIG. 108 toFIG. 111.

(1) When the rod 291 is pushed to the left on the drawing surface asshown in FIG. 108 by operating the operating section 255 (not shown),the first active member 287 can be opened to the position shown in FIG.108. At this time, since no external force is applied to the secondactive member 288 in a direction to open, the second active member 288is opened by the spring 308 to only the position shown in FIG. 108. Whenthe removable needle 213 is inserted into the tissue at an angle θ where45 degrees<θ<110 degrees (preferably, 90 degrees), the tissue ispunctured deep. This makes it possible to reliably suture the tissue.

(2) As shown in FIG. 109, when the second actuating member 219 is movedto the right on the drawing surface, the tissue is punctured with theremovable needle 213 and two fixing needles 229. At this time, thecounterclockwise force acting on the second active member 288 is equalto the biasing force of the spring 308.

(3) As shown in FIG. 110 and FIG. 111, when the rod 291 is further movedto the right on the surface drawing, a contact face 312 of the forcecharging member 300 engages with a contact face 380 of the second activemember 288. As a consequence, in addition to the biasing force, theforce of the force charging member 300 acts on the second active member288. This makes it possible to reliably rotate the second active member288 clockwise. As shown in FIG. 111, to completely close the firstactive member 287 even when a large portion of the tissue is caught, theposition where the contact face 312 engages with the contact face 380 isset in a direction in which the second active member 288 opens. In otherwords, while no tissue is caught, the second active member 288 is incontact with the first active member 287 with only the force of thespring 308. At this time, the contact face 312 is not in contact withthe contact face 380. This makes it possible to match the axis of theremovable needle 213 in FIG. 101 with that of the needle-catching-device212 to a certain extent. Therefore, the needle-catching-device 212 caneasily recover the removable needle 213. Since a suturing procedure isthe same as that in the 10th embodiment (see FIG. 90 to FIG. 98), adescription thereof will be omitted.

(Effects)

In addition to the effects of the 10th embodiment, the tissue can bepunctured deeper, and the removable needle 213 can be easily recovered.

12th Embodiment

FIG. 112 to FIG. 122 show the 12th embodiment.

(Arrangement)

The 12th embodiment differs from the 10th embodiment in the followingpoints.

As shown in FIG. 113, the interval between pins 329 and 330 of asuturing device 374 of the 12th embodiment is larger than that betweenthe pins 235 and 236 in the 10th embodiment. In addition, the intervalbetween the pin 329 and a pin 331, the interval between the pin 330 anda pin 332, the interval between the pin 331 and a pin 333, and theinterval between the pin 332 and the pin 333 are also larger than thosein the 10th embodiment. As in the 11th embodiment, this arrangementallows a first active member 313 to make a larger rotational movement,and also can increase the puncturing force acting on a removable needle213 fixed to a needle holding member 336.

As shown in FIG. 114 and FIG. 117, a second active member 314 can rotateabout the pin 330. A pipe 381 is rotatably fitted on part of the pin330, and a spring 334 is arranged around them. An arm member 382 of thespring 334 is in contact with a contact face 340 formed on the secondactive member 314. As shown in FIG. 118, a force charging member 326 isconnected, through the pin 332, to a second connecting member 316 whichis connected to a rod 317 to be rotatable about the pin 333. A first armmember 325 can pivot about the pin 329. The other arm member 383 of thespring 334 engages with a pin 339 fixed to a holding member 318. Inaddition, as in the 10th embodiment, two fixing needles 324 are mountedon a U-shaped end portion of the second active member 314.

As shown in FIG. 113 and FIG. 119, a stopper 335 is fixed to the secondactive member 314 to prevent the second active member 314 from furtherrotating counterclockwise from the state shown in FIG. 119.

Since a pre-knot cartridge 365 containing the removable needle 213, aneedle-catching-sheath 211, and an operating section 255, which areother constituent members, are the same as those in the 10th embodiment,a description thereof will be omitted. In addition, this embodiment mayuse the arrangement of the removable needle 364 andneedle-catching-device 283 in described in the 10th embodiment.

(Function)

The operation of the suturing device 374 in a case wherein the tissue tobe sutured is punctured will be described with reference to FIG. 119 toFIG. 122.

(1) When the rod 317 is pushed to the left on the drawing surface asshown in FIG. 119 by operating the operating section 255 (not shown),the first active member 313 can be opened to the position shown in FIG.119. At this time, although a counterclockwise force is biased againstthe second active member 314, the member is opened by the spring 335 toonly the position shown in FIG. 119. Note, however, that this device isdesigned to reduce the biasing force of the spring 334 in the stateshown in FIG. 119. When the removable needle 213 is inserted into thetissue at an angle θ where 45 degrees<θ<110 degrees (preferably, 90degrees) as in the 11th embodiment, the tissue is punctured deep. Thismakes it possible to reliably suture the tissue.

(2) As shown in FIG. 120, when the rod 317 is moved to the right on thedrawing surface, the tissue is punctured with the removable needle 213and two fixing needles 229. At this time, since the second active member314 is biased counterclockwise, the member does not rotate.

(3) As shown in FIG. 121 and FIG. 122, when the rod 317 is further movedto the right on the surface drawing, a contact face 341 of the forcecharging member 326 engages with a contact face 342 of the second activemember 314. As a consequence, the second active member 314 rotates in aclockwise direction. Since a suturing procedure is the same as that inthe 10th embodiment (see FIG. 90 to FIG. 98), a description thereof willbe omitted.

(Effects)

In addition to the effects of the 10th embodiment, the tissue can bepunctured deeper.

13th Embodiment

FIG. 123 to FIG. 126B show the 13th embodiment.

(Arrangement)

In the 13th embodiment, the arrangement of the 12th embodiment ismodified as follows.

The spring 334 and pin 339 are removed. A stopper 384 is fixed to asecond active member 349. As shown in FIG. 126B, a holding member 353, afirst active member 348, and the second active member 349 are partlythinned.

(Function)

The operation of a suturing device 385 in a case wherein the tissue tobe sutured is punctured will be described with reference FIG. 123 toFIG. 126A.

(1) When a rod 352 is pushed to the left on the drawing surface as shownin FIG. 123 by operating an operating section 255 (not shown) as in the12th embodiment, a needle holder 357 can be opened to the position shownin FIG. 123. At this time, the second active member 349 opens to theposition shown in FIG. 123 because a transmission member 355 interfereswith a contact face 386 of the second active member 349.

(2) As shown in FIG. 124, when the rod 352 is moved to the right on thedrawing surface, the tissue is punctured with the removable needle 213and two fixing needles 363. At this time, as shown in FIG. 124, thesecond active member 349 is pressed against the tissue and is biasedcounterclockwise by the resultant reaction force.

(3) As shown in FIG. 125 and FIG. 126A, when the rod 352 is furthermoved to the right on the surface of the drawing, a contact face 387 ofthe transmission member 355 engages with a contact face 388 of thesecond active member 349. As a consequence, the second active member 349rotates clockwise. Since a suturing procedure is the same as that in the10th embodiment (see FIG. 90 to FIG. 98), a description thereof will beomitted.

(Effects)

In addition to the effects of the 10th embodiment, the tissue can bepunctured deeper. Furthermore, the suturing device can be thinner thanthe devices of the 11th and 12th embodiments. This improves the field ofview.

14th Embodiment

FIG. 127 to FIG. 128B show the 14th embodiment.

(Arrangement)

In the 14th embodiment, the suturing device of the first embodiment oranother embodiment is designed to extend and retract from an endoscopeas shown in FIG. 127.

The tubes 245 and 227 described in the first embodiment and the like areretractably inserted in the inner holes of a tube holding member 343 andtubes 345 and 344. Valves for hermetic sealing are arranged on theproximal end side of the tubes 344 and 345 to allow the tubes 245 and227 to extend and retract while keeping the airtightness in the tubes344 and 345. The tube holding member 343 is fixed near the distal end ofthe endoscope with a fixing member 346. The fixing member 346 may be anadhesive tape, press-fitting scheme, or the like.

In addition, as shown in FIG. 128B, a protect member 347 may be fixed tothe tube holding member 343 and inserted into the body without using theinsertion assisting tool 84 shown in FIG. 16 or the like.

(Function)

The suturing device is made to extend/retract with respect to theendoscope and approach a region to be sutured by pushing and pulling theproximal end portions of the tubes 245 and 227 with respect to the tubes344 and 345.

(Effects)

The suturing device can be easily made to approach a region to besutured.

After the suturing device is made to approach the region, the region canbe sutured deeper by pressing the device against the tissue.

15th Embodiment

FIG. 129 to FIG. 143 show the 15th embodiment.

(Arrangement)

The 15th embodiment is configured to continuously suture the tissue byusing the suturing device exemplified by the fourth to 14th embodiments.

As shown in FIG. 129, in the 15th embodiment, each of the needle holders216, 336, and 357 in the fourth to 13th embodiments are modified into aneedle holder 396. Likewise, the pre-knot cartridge 365 is modified intoa pre-knot cartridge 407, and each of the needle-catching-devices 212and 283 is modified into a needle-catching-device 390. The pre-knotcartridge 407 is comprised of a removable needle 389, thread 391,pre-knot 397, and the like. The removable needle 389 is comprised of aneedle 392, slide member 393, spring 399, lock members 394 and 395, andthe like. As in the case of the removable needle 213 in the 10thembodiment, the thread 391 is fixed to the needle 392 with a stopper 408formed on the thread. The slide member 393 and needle 392 are slidablyfitted together. The slide member 393 is biased to the left on thedrawing surface by the spring 399. The needle 392 is engaged with theneedle holder 396 by the lock member 394, 395. In the state shown inFIG. 129, the removable needle 389 does not come off the needle holder396. The needle-catching-device 390 is comprised of a tip member 402,inserting member 403, spring 401, release member 404, and the like.Although not shown, the proximal end portion of the tip member 402 isconnected to a flexible member like the needle-catching-sheath 211. Asshown in FIG. 129, the spring 401 is connected to the release member 404and can be moved to the right on the drawing surface. An operatingsection (not shown) is attached to the proximal end portion of therelease member 404 to allow the release member 404 to extend andretract.

The pre-knot 397 is wound around the needle-catching-device 390.

(Function)

A continuous suturing procedure will be described below.

(1) As shown in FIG. 129, the removable needle 389 is inserted into thetissue.

(2) When the needle-catching-device 390 is moved to the left on thedrawing surface as shown in FIG. 130, the spring 401 spreads as shown inFIG. 130 and engages with a recess 400 of the slide member 383 as shownin FIG. 131.

(3) When the needle-catching-device 390 is moved to the right on thedrawing surface as shown in FIG. 132, the spring 401 moves to the lefton the drawing surface. As a result, an engage part 405 restricts thespreading of the spring 401.

(4) When the needle-catching-device 390 is moved to the right on thedrawing surface as shown in FIG. 133, the spring 399 that has biased theslide member 393 to the left on the drawing surface, is compressed tomove the slide member 393 to the right on the surface drawing. At thistime, the lock members 394 and 395 are released from the restriction inthe vertical direction on the drawing surface, and can move as shown inFIG. 133. In this manner, as shown in FIG. 134, the removable needle 389is removed from the needle holder 396.

(5) The needle holder 396 is pulled out from the tissue as shown in FIG.135, and is then returned to the illustrated position shown in FIG. 136.

(6) When the needle-catching-device 390 is moved to the left on thedrawing surface as shown in FIG. 137, the lock members 394 and 395 moveon the engage member 398. At this time, the lock members 394 and 395partly enter recesses 406 and 409 formed in the slide member 393, andhence can move on the engage member 398. In this manner, as shown inFIG. 138, the removable needle 389 can be mounted in the needle holder396 again.

(7) As shown in FIG. 139, the release member 404 is moved to the righton the drawing surface by operating the operating section (not shown) toreturn the spring 401 to the illustrated position in FIG. 139. When theneedle-catching-device 390 is moved to the right on the drawing surfacewhile this state is kept, the spring 401 spreads and comes off the slidemember 393, as shown in FIG. 140 and FIG. 141.

(8) The tissue is continuously sutured by repeating the above operation.When the tissue is completely sutured, a continuous suturing operationlike that shown in FIG. 142 and FIG. 143 can be done by making a knotlike the one shown in FIG. 94 to FIG. 98.

(Effects)

In addition to the effects of the fourth to 14th embodiments, the tissuecan be continuously sutured.

16th Embodiment

FIG. 144 to FIG. 163 show the 16th embodiment.

(Arrangement)

The 16th embodiment differs from the 11th embodiment in the followingpoints.

Since the length of a spring 432 is decreased as compared with that inthe 11th embodiment shown in FIG. 102, a projection member 466 formed onthe distal end of a holding member 292, which interferes with the fieldof view of an endoscope, is omitted. This improves the field of view ina suturing operation (see FIG. 145).

In this embodiment, a suturing operation is performed by using an endloop cartridge 440 shown in FIG. 146 and FIG. 158 in place of thepre-knot cartridge 365 in the 11th embodiment. The end loop cartridge440 is comprised of a removable needle 441, suture thread 442, needlelock mechanism 475, casing member 446, releasing member 447, elasticmember 448, rigid member 449, and the like.

Referring to FIG. 146 and FIG. 158, the suture thread 442 fixed to theremovable needle 441 is pressed into the elastic member 448 arranged inthe casing member 446 through holes 450 and 457 formed in the needlelock mechanism 475. This thread further extends through a hole 476formed in the releasing member 447 to form a loop 451 on the proximalend side. To increase the sliding resistance between the elastic member448 and the suture thread 442, the rigid member 449 is tightly attachedto the elastic member 448 by swaging, caulking, or the like. A lockmember 454 formed on the releasing member 447 engages with a hole 456formed in the casing member 446 to prevent the releasing member 447 fromcoming off the casing member 446. The removable needle 441 is detachablyforced into a needle holding member 434. In this case, the removableneedle 441 and needle holding member 434 may be designed such that aremovable needle 489 having a groove 490 is fitted in the needle holdingmember 434 having an elastically deformable stopper 492 as shown in FIG.165 and FIG. 166 to prevent the removable needle 489 from easily comingoff a needle holding member 491. Alternatively, as shown in FIG. 175 andFIG. 176, a slit like the one shown in FIG. 175 and FIG. 176 may beformed in the needle holder to prevent the removable needle 441 fromeasily coming off the holder.

The casing member 446 is fitted in a distal pipe 425.

As shown in FIG. 147 and FIG. 159, an engage tube 465 comprised of twoengage members 458, a pipe 459 which fixes the proximal end portions ofthe engage members, a tube 460 coupled to the pipe 459, and the like isdesigned to allow a hook device 461 to freely extend and retract. Thehook device 461 is comprised of a flexible coil 462, a hook 463, atransmission member 464 fixed to the hook 463, and an operating section(not shown). The hook 463 can be made to extend and retract by operatingthe operating section. A seal structure made of an O-ring and the likeis formed on the proximal end side of the engage tube 465 to ensureairtightness between itself and the hook device 461.

As shown in FIG. 144, a holding member 416 has a cylinder part 467 andis retractably arranged in an outer sheath 468. In addition, as shown inFIG. 144 and FIG. 160, the outer sheath 468 is comprised of a guide pipe436, guide tube 437, port 471, seal member 472, and the like. With thisarrangement, a tube 420 of a suturing device 410 can keep airtightnessinside the outer sheath 468. An inner sheath 479 shown in FIG. 144 andFIG. 161 is comprised of a tube 439 and port 474 coupled to the distalpipe 425, and a seal member 478, and the like, and is inserted into anouter sheath 480 having a larger inner diameter. In this case, the outersheath 480 is comprised of a guide tube 438, port 473, seal member 477,and the like. With this structure, airtightness in the outer sheath 480is maintained by the seal member 477. The engage tube 465 in which thehook device 461 shown in FIG. 147 is inserted is inserted into the innersheath 479 through the seal member 478. At this time, the airtightnessbetween the tube 460 and the seal member 478 is also maintained.

Referring to FIG. 144, the outer sheath 468 and inner sheath 479 arerespectively formed from the flexible tubular members 437 and 439. Asshown in FIG. 163, however, portions of these members which do not reachthe curved portion of the distal end portion of the endoscope when thesuturing device 410 is mounted in the endoscope may be modified intohard tubes 481 and 482 (e.g., tubes in which thin wires are embedded ina lattice form) which hardly extend and contract. This makes it possibleto apply a large force to members inserted into the outer sheath 468 andinner sheath 479 without interfering with the bending operation of theendoscope.

The engage tube 465 in which the hook device 461 is inserted as shown inFIG. 147 extends through the seal member 478 shown in FIG. 161 and comesoff the distal pipe shown in FIG. 144. By operating the operatingsection (not shown) of the hook device 461 coming off the distal pipe,the loop 451 of the end loop cartridge 440 is hung on the hook 463 andthe hook 463 is pulled in, as shown in FIG. 147. As shown in FIG. 147,FIG. 158, and FIG. 157, the lock member 458 of the engage tube 465 isengaged with a hole 455 of the end loop cartridge 440, and is thenloaded into the distal pipe shown in FIG. 144. FIG. 164 shows the loadedstate.

The structure in which the removable needle 441 is locked to the needlelock mechanism 475 is the same as that shown in FIG. 81 to FIG. 85.

(Function)

A suturing procedure will be described below with reference to FIG. 147to FIG. 157. For the sake of easy understanding of operation, anillustration of the suturing device 410 is omitted from FIG. 147 to FIG.157. In reality, therefore, a suturing operation is performed while theend loop cartridge 440 is loaded as shown in FIG. 164.

(1) The operating section of the suturing device 410 (not shown) isoperated to puncture the tissue with the removable needle 441 as shownin FIG. 147.

(2) As shown in FIG. 148, the hook device 461 and engage tube 465 arepushed into the end loop cartridge 440 to make the removable needle 441engage with the needle lock mechanism 475 of the end loop cartridge 440.

(3) As shown in FIG. 149, when the hook device 461 and engage tube 465are moved to the right on the drawing surface, the removable needle 441is unlocked from the needle holding member 434. At this time, since thelock member 458 is engaged with a needle-catching-body 445 of the endloop cartridge 440, the removable needle 441 can be reliably unlockedfrom the needle holding member 434.

(4) As shown in FIG. 150, when the hook device 461 is pushed to the leftside on the drawing surface, the releasing member 447 is pushed into thecasing member 446, and an inclined portion 453 is engaged with the hole455. At this time, since the lock member 458 moves on the inclinedportion 453, the member is unlocked from the hole 455 (see FIG. 151). Inaddition, since the casing member 446 elastically deforms, the releasingmember 447 can engage with the hole 455.

(5) As shown in FIG. 152, the needle holding member 434 is pulled offfrom the tissue.

(6) As shown in FIG. 153 and FIG. 154, the hook 463 is pulled to fastenthe suture thread 442. At this time, the sliding friction between thesuture thread 442 and the elastic member 448 prevents the sutured regionfrom loosening.

(7) As shown in FIG. 155 and FIG. 156, the hook 463 is pulled out fromthe coil 462, and the loop 451 is unfastened from the hook 463.

(8) As shown in FIG. 157, a redundant portion of the suture thread 442is cut by using a thread cutting forceps 469. In this case, as shown inFIG. 162, the thread cutting forceps 469 is designed to cut the threadby opening/closing scissors members 483 and 484 having sharp cuttingblades. In addition, the thread cutting forceps 469 has recess parts 485and 486 to prevent the thread from escaping from the blades when it iscut. Furthermore, a rotatable sheath 487 allows the thread cuttingforceps 469 to rotate about the axis, and hence the direction of thescissors members 483 and 484 can be freely changed. Since the suturethread 442 is exposed in a space 488 as shown in FIG. 157, when theoperator wants to remove the end loop cartridge 440 after a suturingoperation, he/she can easily remove the end loop cartridge 440 from thetissue by cutting this portion of the suture thread 442.

(Effects)

In addition to the effects of the 10th embodiment, the end loopcartridge 440 can be easily removed from the sutured region. Inaddition, this device allows an easy approach to a region to be sutured.Furthermore, after an approach to the tissue, the tissue can be sutureddeep by pressing the suturing device against the tissue.

17th Embodiment

FIG. 169 to FIG. 171 show the 17th embodiment.

(Arrangement)

The 17th embodiment differs from the 16th embodiment in the followingpoints.

As shown in FIG. 169 to FIG. 171, a third actuating member 494 ispivotally coupled to a first actuating member 501 and third connectingmember 502 by using pins 511 and 510, respectively. The first actuatingmember 501 is pivotally coupled to a holding member 499 with a pin 504serving as a holding shaft, and is also coupled to a first connectingmember 496 with a pin 507. The third connecting member 502 is pivotallycoupled to the holding member 499 with a pin 509. A second actuatingmember 495 is pivotally coupled to the holding member 499 with a pin 505serving as a holding shaft, and is also pivotally coupled to a secondconnecting member 497 with a pin 508. The first and second connectingmembers 496 and 497 are pivotally coupled to a push rod 498 with a pin506. As shown in FIG. 169 and FIG. 170, the first and second actuatingmembers 501 and 495 can be opened/closed by pushing and pulling the rod498. With this operation, the third actuating member 494 is moved by thefirst and third actuating member 501 and 502. Other arrangements are thesame as those in the 16th embodiment, and hence a description thereofwill be omitted.

(Function)

A suturing operation is performed in the same manner as in the sixthembodiment shown in FIG. 147 to FIG. 157. In FIG. 169 and FIG. 170, theend loop cartridge 440, the distal pipe, and the like are omitted.

(Effects)

In addition to the 16th embodiment, the locus of the distal end of aremovable needle 441 can be made a one different from a circular locusaround the pin 504. This makes it possible to puncture the tissuedeeper.

The stroke of the push rod 498 which is required to open/close the thirdand second actuating members 494 and 495 can be reduced.

18th Embodiment

FIG. 172 shows the 18th embodiment.

(Arrangement)

The 18th embodiment differs from the 16th embodiment in the followingpoints.

As shown in FIG. 172, this embodiment has first and second catchingmembers 519 and 520 pivotable about pins 522 and 523. Needle-likemembers are formed on the distal ends of the first and second catchingmembers 519 and 520 to prevent them from sliding on the tissue when theycatch it. In addition, the first and second catching members 519 and 520can operate independently of the opening/closing operation of first andsecond actuating members 517 and 518 owing to a link structure (notshown). Other arrangements are the same as those in the 16th embodiment,and hence a description thereof will be omitted.

(Function)

A suturing operation is performed in the same manner as in the 16thembodiment shown in FIG. 147 to FIG. 157. Note, however, that the tissueis caught by using the first and second catching members 519 and 520before the tissue is punctured with a removable needle 441, and thetissue is punctured with the removable needle 441 after the tissue ispulled up.

(Effects)

In addition to the effects of the 16th embodiment, since the tissue canbe punctured with the removable needle 441 while the tissue is pulled upby the first and second catching members 519 and 502, the tissue can bepunctured deeper.

19th Embodiment

FIG. 178 and FIG. 179 show the 19th embodiment.

(Arrangement)

The 19th embodiment differs from the 16th embodiment in the followingpoints.

As shown in FIG. 178 and FIG. 179, the end loop cartridge 440 ismodified into an end loop cartridge 539, and the engage tube 465 ismodified into an engage tube 543.

The end loop cartridge 539 is comprised of a removable needle 441similar to the one in the 16th embodiment, a suture thread 442, a needlelock mechanism 475, an elastic member 448, a rigid member 449, a casingmember 540, and the like. The engage tube 543 is comprised of two lockmembers 545, a pipe 549 that fixes the proximal end portions of theselock members, a tube 550 coupled to the pipe 549, and the like, and isdesigned to allow a hook device 461 to be retractably arranged inside.

As shown in FIG. 178, after a loop 451 of the end loop cartridge is hungon a hook 463 of the hook device and the loop 451 and suture thread 442are partly pulled into the hook device 461, two lock members 545 of theengage tube 465 are positioned to holes 546 formed in the casing member540. Thereafter, as shown in FIG. 179, the hook device 461 is moved tothe left on the drawing surface to push the lock members 545 upward inthe vertical direction on the drawing surface so as to make it engagewith the hole 546. With this operation, the engage tube 543 and end loopcartridge 539 can integrally engage with each other. In addition, thelock members 545 have elastic arms 559.

(Function)

A suturing procedure is almost the same as that in the 16th embodimentshown in FIG. 147 to FIG. 157 except for the following point.

The operation of disengaging the end loop cartridge 440 from the engagetube 465, which is shown in FIG. 149 and FIG. 150, is modified into theoperation shown in FIG. 178 and FIG. 179. In this case, the lock members545 is unlocked from the hook device 461 by moving the hook device 461to the right on the drawing surface, and the lock members 545 comes offthe hole 546 owing to the elasticity properties of the arms 559.

Other operations are the same as those in the 16th embodiment, and hencea description thereof will be omitted.

(Effect)

In addition to the effects of the 16th embodiment, theattachment/detachment of the end loop cartridge 539 and engage tube 543is facilitated.

20th Embodiment

FIG. 180 and FIG. 181 show the 20th embodiment.

As shown in FIG. 180 and FIG. 181, the end loop cartridge 440 ismodified into an end loop cartridge 539, the engage tube 465 is modifiedinto an engage tube 551, and the distal pipe 425 is modified into adistal pipe 552.

The end loop cartridge 539 is comprised of a removable needle 441similar to the one in the 16th embodiment, a suture thread 442, a needlelock mechanism 475, an elastic member 448, a rigid member 449, a casingmember 540, and the like. The engage tube 551 is comprised of two lockmembers 553, a pipe 554 which fixes the proximal end portions of theselock members, a tube 555 coupled to the pipe 554, and the like, and isdesigned to allow a hook device 461 to be retractably arranged inside.

As shown in FIG. 180, after a loop 451 of the end loop cartridge is hungon a hook 463 of the hook device and the loop 451 and suture thread 442are partly pulled into the hook device 461, two lock members 553 of theengage tube 551 are positioned to holes 546 formed in the casing member540. Thereafter, as shown in FIG. 181, the engage tube 551 and hookdevice 461 are moved to the left on the drawing surface to house the endloop cartridge 539, engage tube 551, and hook device 461 in the distalpipe 552. At this time, when the outer surfaces of the lock members 553come into contact with the inner surface of hole 556 formed in thedistal pipe 552, arms 558 elastically deform. As a result, the lockmembers 553 engage with the holes 546. With this operation, the engagetube 551 and end loop cartridge 539 integrally engage with each other.

A hole 557 larger in diameter than the hole 556 is formed in the distalpipe 552. In this case, since the distal end portion of the end loopcartridge 539 partly becomes large, the large-diameter hole 557 isformed. Obviously, however, if the maximum outer diameter of the endloop cartridge 539 is made smaller than the diameter of the hole 556,such a large-diameter hole 557 need not be formed.

(Function)

A suturing procedure is almost the same as that in the 16th embodimentshown in FIG. 147 to FIG. 157 except for the following point.

The operation of disengaging the end loop cartridge 440 from the engagetube 466 shown in FIG. 149 and FIG. 150 is modified into the operationof disengaging the distal pipe 552 from the hole 556 shown in FIG. 180and FIG. 181. In this case, the engage tube 551 and hook device 461 aremoved to the left on the drawing surface.

Other operations are the same as those in the 16th embodiment, and hencea description thereof will be omitted.

(Effects)

In addition to the effects of the 16th embodiment, theattachment/detachment of the end loop cartridge 539 and engage tube 543is facilitated.

The present invention has been described in conjunction with thepreferred embodiments shown in various drawings. Obviously, however,other similar embodiments can be used to realize the same functions asthose of the present invention, the above embodiments can be modified,or other embodiments can be added without departing from the spirit andscope of the invention. The present invention is not therefore limitedto any single embodiment.

For example, it is obvious that each treatment device described abovecan be used together with a rigid endoscope, trocar, or the like as wellas flexible endoscopes. When each treatment device is to be usedtogether with an endoscope, each treatment device can be inserted intothe body through a proper lumen extending into the endoscope instead ofbeing arranged outside the endoscope as described above.

1. A treatment device for use with at least a flexible endoscope, thetreatment device being used to perform treatment in a body by beingoperated outside the body, comprising: a flexible member configured tobe detachably fixed to an outside of an insert section of the endoscope,the flexible member having a distal end portion which is capable ofbeing inserted into the body with the insert section of the endoscope,the flexible member further including a coil of which contraction in anaxial direction is restricted and which forms an axial hole; atransmission member with a flexible structure which is movably arrangedin the coil in the axial direction and capable of being operated outsidethe body; a link mechanism which is arranged at the distal end portionof the flexible member and actuated by an operation outside the bodythrough the transmission member, the link mechanism including: first andsecond connecting members coupled to a push rod through the transmissionmember, each of the first and second connecting members having a distalend portion and a proximal end portion rotatably coupled to thetransmission member; first and second arm members each having a distalend portion and a proximal end portion rotatably coupled to the distalend portion of a corresponding one of the first and second connectingmembers; a holding member which holds the distal end portions of thefirst and second arm members; and first and second actuating memberswhich are integrally formed with the distal end portions of the firstand second arm members and are able to open/close when the transmissionmember actuates the first and second connecting members and the firstand second arm members through the push rod; a curved needle which ismounted on one of the first and second actuating members and is able tomove in a direction to puncture a tissue and a direction to be removedfrom the tissue; and at least one tissue fixing means which is arrangedat the other one of the first and second actuating members, wherein thetissue fixing means has a needle shape, wherein the distal end portionsof the first and second arm members are rotatably held by the holdingmember at a predetermined interval therebetween to enable the proximalend portions of the first and second arm members to pass between thedistal end portions of the first and second arm members, the thereby thecurved needle and the tissue fixing means are allowed to move between aposition where distal end portions of the curved needle and the tissuefixing means face in the same direction, and a position where the distalend portions of the curved needle and the tissue fixing means face inrespective positions substantially perpendicular to each other, througha position where the distal end portions of the curved needle and thetissue fixing means face each other.
 2. A device according to claim 1,wherein the flexible member has an axis and is so held as to be movablewith respect to the insert section in an axial direction of the insertsection.
 3. The device according to claim 1, further comprising: anouter tube in which the flexible member is insertable and is configuredto be fixed detachably outside the endoscope, wherein the device isconfigured to move forward and backward in an axial direction of theendoscope via the outer tube.
 4. The device according to claim 3,further comprising a tube holding member having at least one lumen whichcommunicates with a lumen of the outer tube, wherein the endoscope isconfigured to be detachably fixed via the tube holding member.
 5. Anendoscopic treatment device which is used together with at least aflexible endoscope to perform treatment in a body by being operatedoutside the body, comprising: a flexible member configured to bedetachably fixed to an outside of an insert section of the endoscope,the flexible member having a distal end portion which is capable ofbeing inserted into the body with the insert section of the endoscope,the flexible member further including a coil of which contraction in anaxial direction is restricted and which forms an axial hole; atransmission member with a flexible structure which is movably arrangedin the coil in the axial direction, has a distal end portion insertedinto a body and is capable of being operated outside the body; a pushrod coupled to the distal end portion of the transmission member; firstand second slender connecting members coupled to the push rod, each ofthe first and second slender connecting members having a distal endportion and a proximal end portion rotatably coupled to the push rod;first and second slender arm members each having a distal end portionand a proximal end portion rotatably coupled to the distal end portionof a corresponding one of the first and second slender connectingmembers; a holding member which rotatably holds the distal end portionsof the first and second slender arm members at a predetermined intervaltherebetween to enable the proximal end portions of the first and secondslender arm members to pass between the distal end portions of the firstand second slender arm members; first and second actuating members whichare integrally formed with the distal end portions of the first andsecond slender arm members and are able to open/close when thetransmission member actuates the first and second slender connectingmembers and the first and second slender arm members through the pushrod; and a needle which is mounted on at least one of the first andsecond actuating members and is used to puncture a tissue; wherein eachof the first and second slender arm members is shorter than each of thefirst and second slender connecting members, and wherein the proximalend portions of the first and second slender arm members are capable ofmoving from a position where they substantially overlap each other to aposition where they are substantially parallel to each other through aposition where they pass between the distal end portions of the firstand second arm members that are held by the holding member.
 6. A deviceaccording to claim 5, wherein at least one of the first and secondactuating members has at least one tissue fixing means.
 7. A deviceaccording to claim 5, wherein the needle is a curved needle.
 8. A deviceaccording to claim 5, further comprising protective means for protectinga tissue from the needle.
 9. A device according to claim 5, furthercomprising a suture thread attached to the needle, and recovery meansfor recovering the thread inserted in the tissue from the needle.
 10. Adevice according to claim 5, wherein the treatment device can beinserted into the body along a guide member having an axis and is soheld as to be movable with respect to the guide member in an axialdirection of the guide member.
 11. The device according to claim 5,wherein the endoscopic treatment device is configured to be integrallyfixed outside the endoscope.
 12. The device according to claim 5,further comprising: an elongated tube in which the transmission memberis insertable; and an outer tube in which the elongated tube isinsertable, wherein the outer tube is configured to be fixed detachablyoutside the endoscope, and the endoscopic treatment device is configuredto move forward and backward in an axial direction of the endoscope. 13.The device according to claim 12, further comprising a tube holdingmember having at least one lumen which communicates with a lumen of theouter tube, wherein the endoscope is configured to be detachably fixedvia the tube holding member.
 14. The device according to claim 5,wherein when the first and second arm members open completely, thedistal end of the needle is substantially parallel to an axis of theendoscopic treatment device.
 15. The device according to claim 5,wherein when the first and second arm members are closed completely, adistal end of the needle is substantially parallel to an axis of theendoscopic treatment device even when a tissue is sandwiched between thefirst and second arm members.
 16. The device according to claim 5,wherein the interval at which the holding member holds the distal endportion of the first and second arm members is larger than each lengthof the first and second arm members, thereby the distal end portion ofthe first and second connecting members being configured to pass betweenthe distal end portion of the first and second arm members.
 17. Anendoscopic treatment device which is used together with at least aflexible endoscope to perform treatment in a body by being operatedoutside the body, comprising: a flexible member configured to bedetachably fixed to an outside of an insert section of the endoscope,the flexible member having a distal end portion which is capable ofbeing inserted into the body with the insert section of the endoscope,the flexible member further including a coil of which contraction in anaxial direction is restricted and which forms an axial hole; atransmission member with a flexible structure which is movably arrangedin the coil in the axial direction, has a distal end portion insertedinto a body and is capable of being operated outside the body; a pushrod coupled to the distal end portion of the transmission member; firstand second slender connecting members coupled to the push rod, each ofthe first and second slender connecting members having a distal endportion and a proximal end portion rotatably coupled to the push rod;first and second slender arm members each having a distal end portionand a proximal end portion rotatably coupled to the distal end portionof a corresponding one of the first and second slender connectingmembers; a holding member which rotatably holds the distal end portionsof the first and second slender arm members at a predetermined intervaltherebetween to enable the proximal end portions of the first and secondslender arm members to pass between the distal end portions of the firstand second slender arm members; first and second actuating members whichare integrally formed with the distal end portions of the first andsecond slender arm members and are able to open/close when thetransmission member actuates the first and second slender connectingmembers and the first and second slender arm members through the pushrod; and a needle which is mounted on at least one of the first andsecond actuating members and is used to puncture a tissue; wherein thetreatment device is fixed through the flexible member to an outside ofthe endoscope, can be inserted into the body together with the endoscopealong a guide member having an axis, and is so held as to be movablewith respect to the guide member in an axial direction of the guidemember.